保留乳头乳晕皮下腺体切除加假体联合补片乳房一期重建与保乳整形手术治疗乳腺癌比较的单中心回顾性研究

背景与目的 中国女性乳腺癌发病年龄早，保乳手术和乳腺切除术后乳房重建是避免乳腺癌患者失去乳房的合理选择。近年来保乳整形术式的推广使得小乳房患者保乳术后仍能维持较好外形。使用假体联合钛网补片（TiLoop Bra）的乳房重建技术相对简单，便于推广，也能在乳房全切后较好重塑乳房外形。本研究通过回顾性分析评估两种方法在手术效果与满足患者术后美观需求方面的优劣，以期为临床决策提供参考。方法 回顾性分析2019年1月—2021年10月在中南大学湘雅医院乳腺外科接受以上两种手术的早期乳腺癌患者资料，其中接受保乳整形手术（保乳组）与保留乳头乳晕皮下腺体切除加假体联合补片一期乳房重建手术（乳房重建组）的患者各40例。收集患者的基本临床病理特征信息，两组的手术时间、术后留置引流管时间、术后住院时间、住院费用以及手术相关并发症等信息，使用Breast-Q量表评估患者术后满意度。结果 保乳组在手术时间、术后留置引流管时间、术后住院时间以及住院费用上均明显优于乳房重建组（均P<0.001）。乳房重建组乳头麻木的发生率明显高于保乳组（P<0.001）；乳房重建组发生皮瓣坏死4例，保乳组无皮瓣坏死发生，但差异无统计学意义（P=0.079）；两组间血肿、切口感染、脂肪坏死和组织挛缩的发生率差异均无统计学意义（均P>0.05）。两组患者的心理健康、身体健康、性健康及对乳房外形的满意度差异均无统计学意义（均P>0.05）。结论 两种手术方式的美学效果相似。皮瓣坏死为假体联合补片一期乳房重建中的严重并发症，背阔肌肌皮瓣覆盖创面可作为补救治疗手段。满足保乳手术适应证的患者，应优先考虑保乳整形的手术方式；存在保乳手术禁忌证的患者，但有乳房外形要求的，合理评估后实施保留乳头乳晕腺体切除加假体联合补片一期乳房重建也是一个可选方案。

Nipple-areola-complex sparing mastectomy with one-stage reconstruction using prosthesis and TiLoop Bra versus oncoplastic breast-conserving surgery for breast cancer: a single center retrospective study

Background and Aims The age of onset of breast cancer in Chinses women is relatively young, so breast-conserving surgery and breast reconstruction following mastectomy are reasonable options to correct breast volume loss in breast cancer patients. With the promotion of breast oncoplastic surgery in recent years, a satisfactory breast shape can be maintained in patients with small-sized breasts after breast-conserving surgery. The breast reconstruction technique using prosthesis combined with a titanium mesh (TiLoop Bra) is relatively simple and easy to popularize, and can also effectively restore the breast shape after total mastectomy. This study was performed to evaluate the pros and cons of the two approaches in terms of surgical efficacy and meeting the functional and cosmetic requirements of patients, so as to provide information for clinical decision-making.Methods The clinical data of patients with early breast cancer undergoing above two procedures from January 2019 to October 2021 in Department of Breast Surgery, Xiangya Hospital, Central South University were retrospectively analyzed. Of the patients, 40 cases each underwent oncoplastic breast-conserving surgery (breast-conserving group) and nipple-areola-complex sparing mastectomy with one-stage reconstruction using prosthesis and mesh (breast reconstruction group). The basic clinicopathologic information of the patients, duration of operative time and drainage after operation, length of postoperative hospital stay, hospitalization cost and the related complications were collected. The outcomes of breast surgery and and patients'' satisfaction with their breasts were assessed using the Breast-Q questionnaire.Results Breast-conserving group was significantly superior to breast reconstruction group in terms of operative time, postoperative drainage time, and postoperative hospitalization time and cost (all P<0.001). The incidence rate of nipple numbness in breast reconstruction group was significantly higher than that in breast-conserving group (P<0.001); skin flap necrosis occurred in 4 cases in breast reconstruction group while in none in breast-conserving group, but the difference did not reach a statistical significance (P=0.079); no significant differences were noted in incidence rates of hematoma, infection, fat necrosis and tissue contracture between the two groups (all P>0.05). There were no significant differences between the two groups in mental health, physical health and sexual health as well as the degree of subjective satisfaction from the patients for their breast shape (all P>0.05).Conclusion The two surgical approaches have a similar aesthetic effect. Skin flap necrosis is a serious complication in breast reconstruction with prosthesis and mesh, for which latissimus dorsi myocutaneous flap can be used as a remedial treatment. Breast-conserving surgery should be preferentially considered in patients who meet the indications. Nipple-areola-complex sparing mastectomy with one-stage reconstruction using prosthesis and mesh is an alternative option after reasonable evaluation for those with contraindications to breast-conserving surgery but with a requirement for the appearance of the breast.