Salhab Mohamed, Al Sarakbi Wail, Joseph Antony, Sheards Susan, Travers Joan, Mokbel Kefah
The Princess Grace Hospital, 42-52 Nottingham Place, London, W1M 3FD, UK.
Int J Clin Oncol. 2006 Feb;11(1):51-4. doi: 10.1007/s10147-005-0538-1.
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.
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).
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).
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.
保留皮肤的乳房切除术（SSM）联合即刻乳房重建术已被视为早期乳腺癌患者的一种有效治疗选择。通过保留乳房的自然皮肤包膜，该术式可使畸形最小化并改善美容效果。本研究旨在评估可手术乳腺癌患者行SSM联合背阔肌（LD）肌皮瓣和/或乳房假体即刻乳房重建术（IBR）后的术后并发症、患者满意度及肿瘤学安全性。
回顾性研究2001年至2005年间连续接受25例SSM联合即刻乳房重建术的21例可手术乳腺癌患者，其中14例行LD皮瓣加假体乳房重建术，11例行单纯假体乳房重建术。患者年龄中位数为44岁（范围30 - 68岁）。采用详细问卷评估患者对手术效果的满意度，问卷包括0（不满意）至10（最满意）的线性视觉模拟量表。20例患者中有8例（40%）需要辅助化疗，仅2例患者需要乳房切除术后放疗。7例患者（33%）采用三叶局部皮瓣技术进行乳头乳晕复合体重建。6例患者（28%）（5例行隆乳术，1例行缩乳术）进行了对侧手术以达到对称。
组织学分析显示，4例患者为单纯导管原位癌（DCIS），20例为浸润性癌（±DCIS），其中5例（25%）有淋巴结转移。1例BRCA - 2携带者的预防性乳房切除术未发现恶性肿瘤。肿瘤大小范围为5至90毫米。所有病例手术切缘均清晰。辅助治疗开始时间未延迟。平均随访13.5个月（范围5 - 46个月），所有患者均未发生局部区域复发。仅1例患者（5%）发生远处转移（骨转移）。总生存率为100%。皮瓣坏死/丢失、假体丢失、伤口感染或需要手术引流的血肿发生率分别为0%、0%、0%和0%。21例患者中有3例（14%）观察到需要行包膜切开术的包膜形成。患者满意度评分中位数为10（范围6 - 10）。
可手术乳腺癌患者行SSM和IBR具有较高的患者满意度和较低的并发症发生率。该手术在肿瘤学上似乎是安全的，即使对于高危（T3或淋巴结阳性）癌患者亦是如此。这一点需要更多患者及更长时间的随访来证实。
