乳腺癌保乳整复手术

保乳整复手术是乳腺癌治疗中的一个基本组成部分。这种治疗方式可以切除大量的乳腺组织,提高美容效果,在使患者满意的同时保持良好的肿瘤学切除原则,减少再切除术和乳腺切除率,并有助于辅助放射治疗计划。 我们复习了近年来各种不同保乳整复手术,并描述了在切除乳腺内不同位置肿瘤的技术应用以及选择不同技术时所考虑患者相关的具体因素。最后,对于这种外科手术类型的肿瘤学安全性的证据及并发症进行了讨论。     

Oncoplastic principles in breast conserving surgery

Oncoplastic surgery (OP) represents a major advance in breast cancer surgery. It is based on three principles: ideal oncology surgery with free margins and adequate local control of disease, immediate breast reconstruction and symmetry, with the transposition of plastic surgery techniques into breast cancer surgery. Its original focus was to improve the quality of life of patients undergoing oncological treatments that can be more effective from the aesthetic-functional point of view than the traditional breast conserving techniques. As it happens with all changes of paradigms, it brings new challenges for the traversal formation of all involved in the treatment of breast cancer. Besides that, it opens to new perspectives of surgical research related to the aesthetic results, quality of life and local control, as well as optimization of operative timing and reduction of both adverse effects and costs. The aim of this review was to present the principles of this approach and the main techniques applied, evaluating its indications and limits in conservative breast cancer surgery.     

Oncoplastic surgery after mammary reduction and mastopexy for bilateral breast cancer lesions: Report of a case

We report a case of bilateral breast cancer lesions treated successfully by partial oncoplastic surgery. A 46-year-old Japanese woman presented with a small mass in the right breast. Mammography showed neither a mass nor calcification in the right breast; however, an irregular-shaped mass lesion was shown in the left breast. Ultrasonography and fine-needle aspiration biopsy revealed ductal carcinoma in situ in the inner-upper quadrant of the right breast and invasive ductal carcinoma in the outer-upper quadrant of the left breast. We considered that it would be difficult to obtain a good symmetrical outcome after partial mastectomy for the bilateral breast lesions because of the asymmetrical location of each lesion and her ptotic breasts. Thus, we performed bilateral partial resection, followed by an inferior pedicle reduction mammaplasty-type operation, with and without axillary lymphadenectomy, and achieved good cosmetic and oncologic results.     

Oncoplastic surgery: the evolution of breast cancer treatment

Oncoplastic surgery is an establish approach that combines conserving treatment for breast cancer and plastic surgery techniques. It allows wide excisions and prevents breast deformities by immediate reconstruction of large resection defects. The procedures are mostly useful for resection of 20-40% of the breast - a group of patients normally treated by mastectomy in the past. Four features are integral to oncoplastic breast surgery: (i) Appropriate surgery for cancer excision. (ii) Partial reconstruction to correct wide excision defects. (iii) Immediate reconstruction with the full range of available techniques. (iv) Correction of volume and shape asymmetries relative to the contra-lateral healthy breast. There are two fundamentally different approaches: (i) volume-replacement procedures, which combine resection with immediate reconstruction by using local flaps (glandular, fasciocutaneous, and latissimus dorsi mini-flaps), and (ii) volume-displacement procedures, which combine resection with a variety of different breast reduction and reshaping techniques, according to the location of the tumor. Oncoplastic surgery increases the oncological safety of breast-conserving treatment because a much larger breast volume can be excised and wider surgical margins can be achieved. Moreover, a "surgical screening" of the contra-lateral breast allows the diagnosis of occult cancers. Among oncoplastic approaches, a very unique technique is the possibility of implant use (augmentation mammaplasty) in case of quadrantectomy and simultaneous delivery of intraoperative radiotherapy to the tumor bed.     

Oncoplastic surgery for Japanese patients with breast cancer of the lower pole

This report presents the results of oncoplastic surgery in three Japanese patients with breast cancer lesions involving the lower pole of the breast. Their breasts were ptotic, and their lesions were considered to be suitable for breast conservation surgery. There were treated with partial mastectomy resection using vertical-scar mammaplasty, with reduction surgery and recentralization of the nipple-areola complex. Two patients underwent a mirror-image biopsy on the contralateral breasts to determine the symmetry. The remaining patient had periareolar incision mastopexy without reduction added for the contralateral breast. A large surgical margin was used to remove excessive skin and parenchymal tissue. Ideal symmetry was achieved by performing reduction and/or mastopexy on the contralateral breast.     

Oncoplastic surgery; volume displacement techniques for breast conserving surgery in patients with breast cancer

Background: Surgical management of breast cancer has drastically changed. Breast-conserving surgery (BCS) has now become a commonly used method for its treatment. Oncoplastic techniques are widely applied with satisfactory aesthetic results. We evaluated the aesthetic and oncological outcomes of BCS with glandular tissue displacement techniques.

Methods: Seventy-five patients with invasive breast cancer were surgically treated by oncoplastic techniques. Preoperative evaluations, including breast and tumor size, localizations and features, were performed by physical examination, imaging methods, and histopathological analysis. Appropriate volume displacement techniques were planned according to breast and tumor size and localization. Early and late aesthetic results were evaluated.

Results: The mean age of the patients was 54 years, and mean tumor size was 25?mm. Tumors were located in the upper–outer quadrant in 44% of patients. Glandular flaps were used in 55 (73%) patients. Racquet mammoplasty was the most preferred method. Nipple areolar complex (NAC) recentralization was performed in 26 (47.3%) of 55 patients with glandular tissue displacement. Therapeutic reduction mammoplasty was performed in 20 patients. All patients underwent adjuvant radiotherapy. After an average follow-up of 24 months, neither locoregional recurrence nor distant metastases were observed. Aesthetic results of the oncoplastic BCS method were very good in 54 (72%) patients.

Conclusion: Breast remodeling by glandular flap displacement after a wide local excision should be the primary aim in patients with breast cancer for better aesthetic outcomes. NAC recentralization is the primary component that could be considered for achieving better results. BCS associated with oncoplastic techniques allows wide excision of larger tumors and provides good and satisfactory aesthetic results at long-term follow-up.     

Laparoscopic surgery for benign lesions of the pancreas

Background: Minimally invasive pancreatic surgery, although known to be feasible and safe, is still not considered a standard procedure. We report our experience with laparoscopic pancreatic surgery in a retrospective case series. Materials and Methods: Fifteen consecutive patients (3 male, 12 female) underwent primarily laparoscopic pancreatic surgery from February 2000 to June 2005. Histologically confirmed diagnoses were: neuroendocrine pancreatic tumors (n = 11), adult nesidioblastosis (n = 1), serous cystadenoma (n = 1), and pseudocysts due to chronic pancreatitis (n = 2). Results: Enucleation (n = 3) or left pancreatic resection with spleen preservation (n = 6) was performed laparoscopically in 9 patients. The mean (+/-standard deviation) operative time was 173 +/- 48 minutes (range, 120-250 minutes) and the mean postoperative hospital stay was 5.5 +/- 1.2 days (range, 5-8 days) for the laparoscopic cases. Conversion to open surgery was necessary in 6 patients because of: closeness of the lesion to the portal/mesenteric vein (n = 3), inadequate intraoperative tumor localization (n = 2), or stapler device dysfunction (n = 1). In these patients, open enucleation (n = 1), middle segment pancreatectomy (n = 2), left pancreatic resection (n = 2), and pylorus-preserving Whipple resection (n = 1) were performed. The mean operative time was 268 +/- 74 minutes (range, 150-360 minutes) with a mean postoperative hospital stay of 8 +/- 2 days (range, 6-10 days). Both operative time and hospital stay were significantly longer in patients with secondary open surgery compared to patients with successful laparoscopic operations. Conclusion: Laparoscopic enucleation or distal pancreatectomy with spleen preservation for benign lesions located in the body or tail of the pancreas can be performed safely, with all the potential benefits of minimally invasive surgery. Preoperative tumor localization is of utmost importance to limit pancreatic mobilization and to avoid blind pancreatic resection and conversion to open surgery.     

Oncoplastic surgery of the breast: rationale and experience of 30 cases

A definition of oncoplastic surgery of the breast is presented, and its objectives and advantages over the usual conservative procedures are discussed. The oncological safety of these procedures are demonstrated, especially in surgery of larger tumors. Technical possibilities are discussed and a classification of the procedures presented. Data from 30 cases operated in our institution are depicted. The need for better training of the breast surgeon is discussed and the advantages of the same surgeon to perform the whole procedure presented.     

Aesthetic surgery for benign disorders of the breast

Those benign breast disorders that are amenable to improvement by aesthetic surgery are discussed from the points of view of indications, techniques, and results.

---

Resumen Se discuten, desde el punto de vista de las indicaciones, técnicas operatorias, y resultados, las entidades benignas que afectan a la glándula mamaria y que son susceptibles de mejoría mediante cirugía estética.

---

Résumé L'amélioration possible des indications, des techniques, et des résultats de la chirurgie esthétique en matière de maladies bénignes du sein est exposée.

     

Immediate cytodiagnosis and imaging in the clinical management of discrete benign breast lesions.

Benign breast disease accounts for the majority of referrals to a specialist breast clinic. Delayed investigation prolongs patient anxiety and increases outpatient waiting lists. Few centres offer the triple test of clinical examination, fine needle aspiration cytology (FNAC) and breast imaging by mammography and/or ultrasonography at initial presentation. We have analysed the practicality of such a service during the 12 months following its introduction in our district general hospital. We studied the cohort of 178 patients who presented with a discrete breast lump which was subsequently shown to be benign. A triple test was performed in 72% of all patients. In 100 patients (56%) this was performed at initial assessment. Of these, 87 had clinically benign disease confirmed by FNAC and breast imaging and they were informed of the results within 3 h. A triple assessment during the initial consultation allows the majority of patients with discrete benign breast disease to be given immediate reassurance.