Kronowitz Steven J, Feledy Jules A, Hunt Kelly K, Kuerer Henry M, Youssef Adel, Koutz Cindy A, Robb Geoffrey L
Department of Plastic and Reconstructive Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
Plast Reconstr Surg. 2006 Jan;117(1):1-11; discussion 12-4. doi: 10.1097/01.prs.0000194899.01875.d6.
Unfortunately, patients who desire repair of contour deformities after partial mastectomy usually present after radiation therapy, which may increase the risk of complications and result in a poor aesthetic outcome. The authors reviewed their experience with repair of partial mastectomy defects to determine the optimal approach to breast reconstruction after partial mastectomy.
Sixty-nine patients who underwent repair of a partial mastectomy defect and received radiation therapy were included in this analysis. The reconstructive techniques were categorized as local tissue rearrangement (LTR), breast reduction, or use of a latissimus dorsi myocutaneous flap or thoracoepigastric skin flap (hereafter referred to as "flap").
Fifty patients underwent immediate reconstruction before radiation therapy, and 19 underwent delayed reconstruction after radiation therapy. The reconstructive techniques in patients with immediate reconstruction were local tissue rearrangement in 28 percent, breast reduction in 66 percent, and flaps in 6 percent. In patients with delayed reconstruction, 32 percent had local tissue rearrangement, 42 percent had breast reduction, and 26 percent had flaps. The complication rates for immediate and delayed reconstruction were 26 percent and 42 percent, respectively. Overall, and in the setting of immediate reconstruction, the flap technique was associated with a higher complication rate than local tissue rearrangement and breast reduction. However, in the setting of delayed reconstruction, the flap technique was associated with a lower complication rate than the other two techniques. Fifty-seven percent of the immediate reconstructions performed with the local tissue rearrangement or breast reduction technique, but only 33 percent of the immediate reconstructions performed with the flap technique, were associated with an excellent or good aesthetic outcome.
Immediate repair of partial mastectomy defects with local tissues results in a lower risk of complications and better aesthetic outcomes than immediate repair of partial mastectomy defects with a latissimus dorsi flap.
遗憾的是，部分乳房切除术后希望修复外形畸形的患者通常在放疗后才就诊，这可能会增加并发症风险并导致美学效果不佳。作者回顾了他们修复部分乳房切除术后缺损的经验，以确定部分乳房切除术后乳房重建的最佳方法。
本分析纳入了69例行部分乳房切除术后缺损修复并接受放疗的患者。重建技术分为局部组织重排（LTR）、乳房缩小术或使用背阔肌肌皮瓣或胸腹皮瓣（以下简称“皮瓣”）。
50例患者在放疗前进行了即刻重建，19例在放疗后进行了延迟重建。即刻重建患者的重建技术中，28%为局部组织重排，66%为乳房缩小术，6%为皮瓣。延迟重建患者中，32%为局部组织重排，42%为乳房缩小术，26%为皮瓣。即刻重建和延迟重建的并发症发生率分别为26%和42%。总体而言，在即刻重建的情况下，皮瓣技术与比局部组织重排和乳房缩小术更高的并发症发生率相关。然而，在延迟重建的情况下，皮瓣技术与比其他两种技术更低的并发症发生率相关。采用局部组织重排或乳房缩小术进行的即刻重建中有57%，但采用皮瓣技术进行的即刻重建中只有33%获得了极佳或良好的美学效果。
与使用背阔肌皮瓣即刻修复部分乳房切除术后缺损相比，使用局部组织即刻修复部分乳房切除术后缺损并发症风险更低，美学效果更好。
