Cochrane R A, Valasiadou P, Wilson A R M, Al-Ghazal S K, Macmillan R D
Nottingham City Hospital Breast Unit, Nottingham, UK.
Br J Surg. 2003 Dec;90(12):1505-9. doi: 10.1002/bjs.4344.
The cosmetic outcome after breast-conserving surgery correlates with psychosocial adjustment. Previous studies have shown that, among other factors, cosmesis is dependent on breast size and weight of the wide local excision specimen. This study assessed cosmetic outcome relative to a combination of these factors-the estimated percentage of breast volume excised (EPBVE).
The study group consisted of 151 women who had undergone breast-conserving surgery. All had previously completed a patient satisfaction questionnaire and an independent panel had assessed cosmetic outcome. Their mammograms were reviewed and breast volume was estimated. A validation series showed cone volume on the oblique mammogram to predict true breast weight most accurately (r = 0.93).
Both subjective cosmetic assessment and patient satisfaction correlated strongly with EPBVE. Overall, when the EPBVE was below 10 per cent, 83.5 per cent of patients were very satisfied with their appearance and only 3.1 per cent were not satisfied, compared with 37.0 and 16.7 per cent respectively if the EPBVE was more than 10 per cent. However, tumour location in the breast was also an important factor; cosmetic outcome was worse for medial tumours.
The percentage of breast volume excised was an important determinant of cosmesis and patient satisfaction after breast-conserving surgery. Calculating the EPBVE before surgery may help select women in whom breast reshaping or volume replacement should be considered.
保乳手术后的美容效果与心理社会适应情况相关。既往研究表明，除其他因素外，美容效果取决于乳房大小和广泛局部切除标本的重量。本研究评估了相对于这些因素组合——估计切除乳房体积百分比（EPBVE）的美容效果。
研究组由151例行保乳手术的女性组成。所有患者此前均已完成患者满意度调查问卷，且有一个独立小组对美容效果进行了评估。对她们的乳房X线照片进行了复查并估计了乳房体积。一个验证系列显示，斜位乳房X线照片上的圆锥体积能最准确地预测真实乳房重量（r = 0.93）。
主观美容评估和患者满意度均与EPBVE密切相关。总体而言，当EPBVE低于10%时，83.5%的患者对自己的外观非常满意，只有3.1%的患者不满意；相比之下，当EPBVE超过10%时，这两个比例分别为37.0%和16.7%。然而，肿瘤在乳房中的位置也是一个重要因素；内侧肿瘤的美容效果较差。
切除乳房体积的百分比是保乳手术后美容效果和患者满意度的重要决定因素。术前计算EPBVE可能有助于选择那些应考虑进行乳房重塑或容积替代的女性。
