20例保留皮肤的乳腺癌全乳切除和即刻乳房再造

选择早期乳腺癌患者20例,行保留皮肤的乳腺癌改良根治术后即刻植入假体(14例)或背阔肌肌皮瓣(2例),或联合乳房再造(4例),部分保留乳头乳晕复合体.20例患者中,保留乳房皮肤及部分保留乳头乳晕,均未见局部复发.再造效果优6例,良12例,尚可2例,无严重变形病例.无严重并发症,均按时进行辅助治疗.保留乳房皮肤及乳头乳晕的乳腺癌全乳切除术局部复发率低,术中即刻假体、背阔肌肌皮瓣或联合乳房再造手术效果好,并发症少.     

乳腺癌术后一期乳房再造

背景与目的：乳房再造使乳腺癌全乳切除患者重获完整的乳房外形。本文介绍乳腺癌术后应用带蒂背阔肌肌皮瓣联合或不联合假体和带蒂横向腹直肌肌皮瓣（TRAM）行一期乳房再造的经验，并探讨适合中国乳腺癌患者的乳房再造方式。方法：2000年1月-2005年7月，74例乳腺癌患者乳房切除后，应用背阔肌肌皮瓣或带蒂TRAM行一期乳房再造。结果：再造手术均取得成功，背阔肌肌皮瓣再造62例（83．8％），其中联合假体13例、带蒂TRAM再造12例、联合假体1例。经过2～66个月随访，局部区域复发率4．1％。患者满意度高，可接受度96％。而且这两种自体再造方式在是否需要联合假体上没有差别（P=0．440）。结论：乳腺癌术后一期乳房再造能同时满足肿瘤治疗和形体美容的要求，提高患者生活质量，背阔肌肌皮瓣再造对中国女性适用性好，值得推广。     

保留乳房手术及外侧组织瓣乳房成型治疗乳腺癌的应用体会

1997-2002年对18例早期原发乳腺癌(Tis-T2A)进行保留乳房 外侧组织瓣乳房成形术。结果 18例手术均获成功，切口Ⅰ期愈合，乳头无坏死。10例患者术后随访2年以上，均无肿瘤局部复发及转移。初步研究结果提示，应用外侧软组织皮瓣(lateral tissue flap，LTF)乳房成型，有良好临床效果和使用价值。     

保留乳房手术及外侧组织瓣乳房成型治疗乳腺癌的应用体会

1997-2 0 0 2年对 18例早期原发乳腺癌 (Tis T2 A)进行保留乳房 +外侧组织瓣乳房成形术。结果 18例手术均获成功 ,切口Ⅰ期愈合 ,乳头无坏死。 10例患者术后随访 2年以上 ,均无肿瘤局部复发及转移。初步研究结果提示 ,应用外侧软组织皮瓣 (lateraltissueflap ,LTF)乳房成型 ,有良好临床效果和使用价值。     

乳腺癌保留乳房肿瘤整形术合并同期健侧乳房对称性整形手术10例分析

保留乳房手术已成为早期乳腺癌的标准治疗方法。保留乳房手术加放射治疗可获得与乳房全切同样的局部复发率及生存率[1-2]。但是,若肿瘤扩大切除组织超过乳腺体积的20%[3],或肿瘤位于内下象限等美容敏感区域,常常出现难以接受的乳房畸形,比如局部凹陷、乳头偏斜等,严重影响保留乳房手术的效果。近年来,为减少局部复发及术后乳房畸形,乳房整形技术在保留乳房手术中得到应用,使切除组织增加的同时并能较好的维持乳房形     

治疗性缩乳成形术在乳房肥大患者乳腺癌保留乳房手术中的应用

乳房肥大(巨乳症)合并乳腺癌的患者接受传统保留乳房治疗后往往会出现难以接受的美容并发症。乳房肥大的乳腺癌患者行保留乳房手术后,放射治疗常常导致乳房外形不佳,巨大乳房又会影响放射治疗的剂量分布和定位,影响放射治疗效果。治疗性缩乳成形术可以使乳房肥大的乳腺癌患者达到保留乳房和美容成形的双重效果。笔者从治疗性缩乳成形术的肿瘤治疗安全性、并发症以及手术方式等方面对其进行全面总结。既往研究结果表明,治疗性缩乳成形术不仅可以提供安全的肿瘤治疗方式,还可以防止或减轻合并症,成为乳房肥大的乳腺癌保留乳房患者的有利选择。     

保留乳头乳晕乳房切除-重建术研究进展

保留乳头乳晕乳房切除-重建术是近年来乳腺癌外科治疗的新方向和热点问题。相比于传统改良根治术,保留乳头乳晕乳房切除-重建术保留乳腺癌患者形体上完整,弥补了患者乳房缺失的心理缺失。然而保留乳头乳晕乳房切除-重建术在乳腺癌外科治疗上的安全性一直广受争议,手术适应证也未完全明确,手术切口选择、切缘处理及重建方式选择失当导致的乳头坏死等问题也亟须进一步探讨。笔者将从以上几个角度探讨一下保留乳头乳晕乳房切除-重建术研究的最新进展。     

保留乳房天然结构的乳腺癌改良根治术后即刻乳房成形术的临床应用

目的探讨保留乳房天然结构的乳腺癌改良根治术后即刻自体组织乳房成形术在临床中的运用价值。方法乳腺癌患者12例,其中DCIS 6例,浸润性导管癌3例,小管癌1例,髓样癌1例,黏液癌1例;保留乳房皮肤的乳腺癌改良根治术9例,保留乳头乳晕复合体的乳腺癌改良根治术3例。全组均保留或重建乳房下皱襞,切除乳腺组织和腋窝淋巴结,应用下腹部横行腹直肌肌皮瓣或背阔肌肌皮瓣即刻乳房成形。结果横行腹直肌肌皮瓣乳房成形术3例,背阔肌肌皮瓣乳房成形术9例,术后皮瓣均存活,皮瓣血管通畅,成形乳房外观良好。结论对早期乳腺癌患者行保留乳房天然结构的乳腺癌改良根治术后即刻自体组织乳房成形,切口隐蔽,成形乳房形态效果良好,可以获得较好的美容效果。     

乳腺切除术后全乳再造37例临床研究

目的探讨带血管蒂转移皮瓣在乳腺癌术后乳房再造中的安全性和整形效果。方法2004年3月—2010年6月,对37例乳腺肿瘤患者,行乳房切除术后带蒂背阔肌或TRAM皮瓣乳房再造。其中Ⅰ期再造34例,Ⅱ期再造3例;对其中15例TRAM皮瓣再造的供区下腹部应用涤纶补片加强腹壁。结果1例TRAM皮瓣小部分坏死,6例Ⅰ期再造术后乳房本体皮肤坏死。3例背阔肌皮瓣再造发生背部皮下血清肿;3例TRAM皮瓣下腹中段脂肪液化,无腹壁膨隆或腹壁疝发生。随访2月—72月,1例肿瘤局部复发,1例肝转移。乳房外观评价,总体可接受度94.59％。 结论背阔肌或TRAM带血管蒂转移皮瓣再造是乳房切除术后行全乳再造的有效和安全的方法,应用涤纶补片加强腹壁可以有效预防腹壁软弱和腹壁疝形成。     

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。     

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.     

Skin-sparing mastectomy and immediate breast reconstruction: patient satisfaction and clinical outcome

Background Skin-sparing mastectomy (SSM) followed by immediate reconstruction has been advocated as an effective treatment option for patients with early-stage breast carcinoma. It minimizes deformity and improves cosmesis through preservation of the natural skin envelope of the breast. The purpose of this study was to evaluate postoperative morbidity, patients' satisfaction, and oncological safety for SSM and immediate breast reconstruction (IBR) with a latissimus dorsi (LD) myocutaneous flap and/or breast prosthesis in patients with operable breast cancer. Methods Twenty-one consecutive patients with operable breast cancer undergoing 25 SSM and immediate reconstruction with an LD flap plus implant (n = 14) or implant alone (n = 11) were retrospectively studied (from 2001 through 2005). The median patients' age was 44 years (range, 30–68). Patient satisfaction with the outcome of surgery was assessed using a detailed questionnaire including a linear visual analogue scale ranging from 0 (not satisfied) to 10 (most satisfied). Eight of 20 (40%) patients required adjuvant chemotherapy, and only 2 patients required post-mastectomy radiation. Reconstruction of the nipple–areola complex was performed in 7 patients (33%) using the trefoil local flap technique. Contralateral procedures to achieve symmetry were performed in 6 (28%) patients (5 augmentations and 1 reduction mammoplasty). Results Histological analysis showed pure ductal carcinoma in situ (DCIS) in 4 patients and invasive carcinoma (+/− DCIS) in 20 cases, of which 5 (25%) were node positive. One prophylactic mastectomy in a BRCA-2 carrier was negative for malignancy. Tumor size ranged from 5 to 90 mm. The surgical margins were clear in all cases. There was no delay in time to commencement of adjuvant therapies. After a mean follow-up period of 13.5 months (range, 5–46 months), none of the patients developed locoregional recurrence. Only 1 patient (5%) developed systemic recurrence (bony metastases). Overall survival was 100%. The incidence of flap necrosis/loss, implant loss, wound infection, or hematoma requiring surgical evacuation was 0%, 0%, 0%, and 0%, respectively. Capsule formation requiring capsulotomy was observed in 3 of 21 patients (14%). The median patient satisfaction score was 10 (range, 6–10). Conclusion SSM and IBR for operable breast cancer is associated with a high level of patient satisfaction and low morbidity. The procedure seems to be oncologically safe, even in patients with high-risk (T3 or node-positive) carcinoma. The latter needs to be confirmed with greater numbers of patients and longer follow-up.     

Skin-sparing mastectomy and immediate reconstruction with a deep inferior epigastric perforator flap

BACKGROUND: It is important for breast reconstruction after mastectomy to recreate immediately good breast symmetry with an adequate amount of soft tissue. METHODS: Eight patients with breast cancer underwent skin-sparing mastectomy and immediate reconstruction with a deep inferior epigastric perforator flap. This operative technique, and the results, advantages, and disadvantages of the technique were assessed. RESULTS: Seven patients had stage IIA disease, and one patient had stage I disease. An arc-shaped incision was made just at the lateral border of the breast in all patients. Three patients had a separate periareolar incision, and one had a circumferential nipple incision. There was 100% flap survival, and good breast symmetry was achieved in all patients. No major perioperative complications occurred in this series. A small amount of fat necrosis occurred in one flap. One patient had slight abdominal bulging. Minor wound-healing problems at the lateral breast skin envelope occurred in two patients. CONCLUSION: These data indicate that skin-sparing mastectomy and immediate reconstruction with a DIEP flap is a reliable and safe technique. This method is a potentially useful surgical technique, which has achieved very promising results.     

Locoregional recurrence following nipple-sparing mastectomy with immediate breast reconstruction: Patterns and prognostic significance

IntroductionThere are limited available data on the prognostic implications of locoregional recurrence (LRR) after nipple-sparing mastectomy (NSM) and immediate reconstruction. In this study, we investigated the patterns and prognosis associated with LRR following this treatment approach for breast cancer.MethodsA total of 1696 patients with primary breast cancer who underwent NSM with immediate reconstruction from March 2003 to December 2016 were retrospectively analyzed. Post-recurrence disease-free survival (DFS) and distant metastasis-free survival (DMFS) rates were calculated using the Kaplan-Meier method and compared using the log-rank test. Univariate and multivariate analyses using the Cox proportional hazards model were performed to evaluate the prognostic factors associated with the DFS and DMFS.ResultsAfter a median follow-up period of 84 months, we identified 172 patients (10.1%) with an LRR as the first event. The 5-year post-recurrence DFS rates for the nipple-areola complex recurrence (NCR), skin or subcutaneous recurrence/chest wall recurrence (SCR/CWR), and regional recurrence (RR) groups were 89.1%, 73%, and 59.4%, respectively (P = 0.009), and the 5-year post-recurrence DMFS rates for the NCR, SCR/CWR, and RR groups were 96%, 82.8%, and 59.7%, respectively (P < 0.001). In multivariate analysis, a time to LRR ≤2 years (P = 0.016) and the site of LRR (P = 0.022) were significantly associated with the post-recurrence DFS.ConclusionsNCR is more likely to be detected as a non-invasive recurrence and is associated with more favorable overall outcomes than other LRR types. The interval to LRR and its site of onset seem to be associated with the prognostic outcomes.     

Esthetic evaluation of immediate breast reconstruction after nipple-sparing or skin-sparing mastectomy

BACKGROUND: It has been reported that immediate autologous tissue breast reconstruction after nipple-sparing mastectomy (NSM) or skin-sparing mastectomy (SSM) is esthetically superior to autologous tissue reconstruction after conventional mastectomy (CM). We evaluated reconstructed breasts to determine whether these methods contribute to breast appearance other than skin texture. METHODS: Between April 1992 and September 2001, forty-two patients underwent immediate breast reconstruction using autologous tissue. Mastectomy options were NSM, SSM and CM. Postoperative photographs were evaluated using a subscale (volume, contour, placement, and inframammary fold) on a 0-2 point scale. Sternal notch to nipple distances of the affected and normal sides were measured with photographs to estimate nipple-areola complex (NAC) position. No corrective procedure was performed in a later phase before evaluation. RESULTS: NSM was performed in 22, SSM in 6 and CM in 14 cases. On esthetic evaluation, the NSM and SSM groups received 4.96 and the CM group received 4.63. There were no significant differences. In the NSM and SSM group, the NAC position rose in cases with partial necrosis or fat lysis compared with the no complication group (p = 0,004). CONCLUSIONS: Autologous tissue breast reconstruction after NSM or SSM is esthetically equal to autologous tissue reconstruction after CM with regard to parameters other than skin texture. Preserved or simultaneously reconstructed NAC sometimes emphasizes nipple-areola asymmetry when breast deformity has occurred.     

Mammary carcinoma — multidisciplinary treatment with bilateral mastectomy and immediate reconstruction

The classical concepts pertaining to the natural history of mammary carcinoma and its treatment must be reviewed if survival rate is to be improved. By the time diagnosis is established, a fair amount of cases of carcinoma of the breast present distant, clinically undetectable micrometastases, which will not be affected by local therapy (surgery or radiation). Increasing evidence shows that mammary carcinoma nowadays must be looked upon as a diffuse disease affecting both breasts. Postoperative radiation does not improve the 5- and 10-year survival rates and has a negative effect upon the immunological defense of the patient. Immunology plays an important role in the evolution and cure of the patient with carcinoma of the breast. The mutilation produced by radical or ultraradical mastectomy may throw the patient into mental depression which, as a consequence, may decrease the immunological competence of the patient. Multiple drug chemotherapy, started at the time of surgery and continued for several months thereafter, may kill micrometastases. Preventive immunotherapy seems to be beneficial to the patient in attempting control of metastases.     

Local recurrence of stage 1 and 2 breast cancer after skin-sparing mastectomy and immediate breast reconstruction in a 15-year series

Aims

Since the introduction of skin-sparing mastectomy (SSM) in 1991 concerns on local control and recurrence rates have been discussed in the literature. The aim of this study is to examine in particular incidence of local recurrence in a 15-year consecutive series of breast cancer patients having undergone SSM and immediate breast reconstruction (IBR) at a single population-based institution.

Methods

One hundred and forty-six consecutive patients with either stage 1 or 2 breast cancer who underwent SSM followed by IBR from 1992 to 2006 were included in this study. A retrospective review of patient records was conducted.

Results

During a mean follow-up time of 51 months, four local recurrences of the native breast skin were accounted for. In addition, three regional lymph node recurrences and four systemic recurrences took place. All of the local and regional recurrences were handled by salvage surgery followed by adjuvant oncological therapies. During a mean follow-up of 35 months after the detection and treatment of the locoregional recurrences none of the patients developed new recurrences.

Conclusions

Our present study concludes that SSM followed by IBR seems oncologically sound procedure for stage 1 and 2 breast cancer patients. In addition, local recurrences and regional lymph node recurrences are not always associated with systemic relapse.