New concept for immediate breast reconstruction for invasive cancers: feasibility,oncological safety and esthetic outcome of post-neoadjuvant therapy immediate breast reconstruction versus delayed breast reconstruction: a prospective pilot study

Feasibility and oncological safety of post-adjuvant skin-sparing mastectomy (SSM) plus immediate breast reconstruction (IBR) cannot be evaluated by randomized trials. However, comparative study could modify guidelines for the oncosurgical treatment of invasive breast cancer. Our study compared the feasibility, oncological safety and esthetic outcome of SSM plus latissimus dorsi (LD) flap IBR after chemotherapy (CT) and radiotherapy (RT) with the standard management for invasive breast cancer: mastectomy as primary treatment, adjuvant CT and RT, and LD flap delayed breast reconstruction (DBR). Twenty-six selected patients with stages IIA–IIIA breast cancer were offered post-neoadjuvant SSM plus IBR with LD flap plus implant (IBR group). Seventy-eight other patients had primary mastectomy, adjuvant CT and RT, and LD-assisted DBR (DBR group). After 4.1 years (range 1–8) of follow-up, feasibility, oncological safety, and esthetic outcome were compared. Sixteen (61%) early complications were reported for the IBR group versus 44 (56%) for the DBR group (P = 0.645). Early implant loss was 0% in IBR versus 12% in DBR. IBR had 8 (30%) late complications versus 17 (21%) for DBR (P = 0.362). Capsular contracture and reconstruction failure rates were similar. Local recurrence was 7.7% (2/26) in IBR and 6.4% (5/78) in DBR (P = 0.823). Cosmetic evaluation by independent physicians and by the patients themselves was identical in the two groups. Our concept provides a basis for offering more women the opportunity to elect for immediate reconstruction, even in the setting of radiation therapy.     

The psychological impact of immediate rather than delayed breast reconstruction.

AIMS: A retrospective analysis of the psychological advantages of immediate reconstruction (IR) against delayed reconstruction (DR). METHODS: A total of 121 patients who underwent different types of breast reconstruction were seen in the follow-up clinic and assessed for: anxiety, depression, body image, self-esteem, sexuality and satisfaction. RESULTS: Ninety-five percent of the patients who had IR preferred this technique and 76% of the DR group would have preferred IR. Anxiety and depression were decreased and body image, self-esteem and sexual feeling of attractiveness and satisfaction were significantly superior in the IR group compared with that of the DR group. CONCLUSION: Patients who had immediate reconstruction recalled less distress and had better psychosocial well being than those who had delayed reconstruction.     

Skin-sparing mastectomy and immediate breast reconstruction

Skin-sparing mastectomy is a new surgical approach that allows a mastectomy while preserving the natural envelope of the breast. Skin-sparing mastectomy followed by immediate reconstruction can be used for prophylaxis for high- risk patients or BRCA carriers. It represents an effective treatment option for patients with extensive DCIS or early invasive breast cancer, but is contraindicated for inflammatory breast cancer and extensive skin involvement by the tumor. Skin-sparing mastectomy had similar surgical outcomes compared to non- skin- sparing mastectomy, but skin flap ischemia and necrosis is more common and is associated with a range of risk factors, including smoking. Skin-sparing mastectomy seems to be an oncologically safe technique and does not increase in particular the risk of local, regional or systemic recurrences. It facilitates immediate breast reconstruction using implants or myocutaneous flaps, resulting in excellent cosmesis and high level of patient satisfaction. This article reviews the published data on skin-sparing mastectomy and immediate reconstruction and aim to establish its current role in clinical practice, as there is a lack of prospective data.     

保留皮肤的全乳切除术和一期乳房再造

保乳手术为乳腺癌病人提供了保留乳房的机会,但仍有病人达不到保乳条件而行全乳切除者。术后一期再造可以满足病人的美容要求。随着乳房切除术后一期再造的开展,对再造乳房的外形美观要求也大大上升。保留皮肤的全乳切除术（skin-sparing mastectomy SSM）灵活选择切口,合理选择对象,不仅在切除全部乳腺的同时最大程度保留皮肤,达到根治性目的;而且并不会因为保留皮肤而提高局部复发率,也不对生存有影响。一些一期再造病人适合行SSM以达到治疗和美容的双重效果。再此基础上,保留乳头或保留乳晕的全乳切除术（nipple-sparing mastectomy NSM或areola-sparing mastectomy ASM）也得到了应用。     

保留皮肤的乳腺癌改良根治术后即刻乳房再造的临床应用

目的探讨保留皮肤的乳腺癌改良根治术后即刻再造乳房的适应证、方法、效果及可行性。方法2002年1月至2007年11月本院对94例乳腺癌患者行保留乳房皮肤皮下乳腺组织切除加腋窝淋巴结清扫术后，应用下腹部横行腹直肌肌皮瓣（transverse rectus abdominis myocutaneous flap，TRAM）、背阔肌肌皮瓣（latissimus dorsi myocutaneous flap，LDM）联合或不联合假体、单纯乳房假体植入4种方式即刻再造乳房。结果再造手术均取得成功。带蒂TRAM再造47例，LDM再造共42例（其中联合假体28例），单纯乳房假体植入5例。4例出现轻微术后并发症（4．25％）。经过3～67个月随访，局部区域复发率为0，再造乳房形态自然，效果满意，术后外观评价优良率97．87％。结论合理选择病例行保留皮肤或保留乳头乳晕乳腺癌改良根治术后即刻乳房再造是安全可靠的，切口隐蔽并能够保留原有乳房皮肤的感觉，从而获得最佳美容效果，值得广泛推广和应用。     

即刻乳房再造在乳腺癌手术中的应用与探讨

目的探讨即刻乳房再造在乳腺癌手术中的应用价值。方法自2005年10月至2009年2月共完成了26例乳腺癌改良根治即刻乳房再造手术,其中10例为局部晚期乳腺癌。即刻腹直肌肌皮瓣乳房再造术12例,背阔肌肌皮瓣乳房再造术8例,保留乳头乳晕复合体皮下乳腺全切假体植入乳房再造术5例,保留乳头乳晕复合体皮下乳腺全切背阔肌肌皮瓣结合假体植入乳房再造术1例。结果全组手术切缘病理均达到阴性,皮瓣全部成活,无假体相关并发症,亦无腹壁疝发生。再造乳房形态满意,肌皮瓣再造乳房可以安全地耐受术后放疗,随访1～40个月无局部复发病例。结论即刻乳房再造手术从根本上改善了乳腺癌患者术后的生活质量,在局部晚期乳腺癌手术中,肌皮瓣乳房再造还可以为足够的切除范围提供安全保障,颇具临床应用价值。     

乳腺癌切除即刻乳房再造术中假体的选择

目的: 研究乳腺癌切除即刻乳房再造术中选择假体的方法,探讨即刻假体乳房再造的适应证。 方法: 收集2007年6月至2012年6月南昌市第三医院乳腺肿瘤科的乳腺癌切除术患者121例,其中乳腺癌改良根治术32例、单纯乳腺切除术89例。乳腺切除后根据阿基米德法计算缺失乳房体积,并测量切除组织直径,以切除组织的体积和直径为依据选择乳房假体,并置入胸大肌及前锯肌后间隙。 结果: 术后随访6~72个月,术后无假体外露、皮瓣坏死以及感染等并发症,出现血清肿4例。对患者行手术效果满意度问卷调查结果显示,手术效果非常满意89.3%（108/121）、满意9.0%（11/121）、不满意1.7%（2/121）。 结论: 在乳腺癌切除术同时采用乳房假体行即刻乳房再造可避免供区损伤,是一种理想的即刻乳房再造方法。采用阿基米德法对缺失乳房组织量进行计算并测量切除组织的直径,可相对准确地得到假体的参数,避免选择假体的盲目性,有利于获得良好的乳房再造手术效果。      

全乳切除术后延迟与即刻重建术在中青年乳腺癌患者中的应用效果

目的 探讨全乳切除术后延迟或即刻重建术在中青年乳腺癌患者中的应用效果.方法 根据治疗方案将104例中青年乳腺癌患者分为即刻组(n=60)和延迟组(n=44),即刻组患者乳腺癌根治术后即刻行乳房重建术,延迟组患者乳腺癌根治术后6～12个月行乳房重建术.比较两组乳房外观、血清肿瘤标志物[糖类抗原15-3(CA15-3)、癌...     

Skin sparing mastectomy and immediate breast reconstruction: A review

Aims

Skin Sparing Mastectomy (SSM) is widely practised now in major centres which manage large numbers of breast cancer but anxiety still exists over the safety of SSM both from oncological and aesthetic points of view. We aim to review literature to date in SSM and summarise and discuss the current evidence.

Methods

Studies were identified by an online search of the English language literature in the PubMed database till April 2012 followed by an extensive review of bibliographies from relevant articles.

Results

There is abundance of evidence with regards to the safety of SSM both oncologically and aesthetically especially in immediate breast reconstruction. The use of SSM technique broadens the repertoire of oncoplastic techniques and at the same time facilitates such techniques by preserving patient's native skin and anatomical landmarks.

Conclusions

SSM is a safe technique providing better cosmetic outcome without compromising oncological safety as per the current evidence. However, prospective data collection of its application in various newer types of reconstructions, and continuing long-term follow-up of current data series would be prudent to evaluate long-term outcomes.     

The oncological implications of immediate breast reconstruction.

AIMS: The timing of breast reconstruction following mastectomy has been an area of contention. The purpose of this study was to report the oncologic safety of mastectomy and immediate breast reconstruction, primarily with a tissue expander. METHODS: We offered 54 patients (58 reconstructions) an immediate breast reconstruction after a modified radical mastectomy was done for invasive breast cancer. RESULTS: Fifty-eight mastectomies were done for an invasive cancer. Thirteen out of 54 women suffered relapse of their cancer and nine patients died of their disease during the follow-up period. Only in one patient a local recurrence was detected at an early stage and treated without removal of the prosthesis. Disease free survival for all patients was 93% at 5 years. CONCLUSION: Immediate breast reconstruction after mastectomy is an oncologically safe approach and represents a clear improvement in the quality of life for patients with breast cancer. Thus this procedure can safely be offered to appropriately selected women.     

即刻乳房再造在乳腺癌治疗中的应用

随着乳腺癌治疗水平与整形外科技术的提高,即刻乳房再造越来越广泛地应用于乳腺癌的治疗中,成为乳腺癌综合治疗的一部分,因而即刻再造与乳腺癌辅助治疗的关系及其可能对乳腺癌预后带来的影响成为研究的热点.本文对近年来这一方面的研究进展做一综述.     

Options for immediate breast reconstruction following skin-sparing mastectomy

Background  Skin-sparing mastectomy (SSM) is a type of breast cancer surgery presupposed as breast reconstruction surgery. Cosmetically, it is an extremely effective breast cancer operation because the greater part of the breast’s native skin and infra-mammary fold are conserved. All cases of SSM and immediate breast reconstruction performed by the senior author during the last five years were reviewed. as]Methods: There are three implant options for breast reconstruction, namely, deep inferior epigastric perforator (DIEP) flap, latissimus dorsi myocutaneous (LDM) flap, and breast implant, and one of these was used for reconstruction after comprehensive evaluation. Results  From 2001 to 2005, immediate reconstructions following SSM were performed on 124 cases (128 breasts) by the same surgeon. Partial necrosis of the breast skin occurred in 4 cases of SSM. The mean follow-up was 33.6 months. During the follow-up, there was local recurrence following surgery in 3 cases. The overall aesthetic results of immediate breast reconstruction after SSM are better than those after non-SSM. Conclusion  SSM preserves the native breast skin and infra-mammary fold, and is an extremely useful breast cancer surgery for breast reconstruction. SSM is an excellent breast cancer surgical technique. We think this procedure should be considered in more facilities conducting breast reconstruction in Japan.