Tuli Richard, Flynn Ryan A, Brill Kristin L, Sabol Jennifer L, Usuki Kenneth Y, Rosenberg Anne L
Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Breast J. 2006 Jul-Aug;12(4):343-8. doi: 10.1111/j.1075-122X.2006.00273.x.
Augmentation mammaplasty is rapidly becoming one of the most frequently performed cosmetic surgeries. However, as the augmented patient population ages, major concerns associated with the screening, diagnosis and treatment of breast cancer are being realized. Although current evidence convincingly indicates that breast implants do not play a role in inducing localized or systemic disease, particularly breast cancer, recent studies have shown implants not only reduce the sensitivity of mammography, but interfere with mammographic detection, possibly leading to delayed breast cancer diagnosis. In addition, the risk for local recurrence, as well as unfavorable cosmetic results, breast fibrosis, and capsular contracture following radiation therapy as part of breast-conserving therapy in previously augmented patients are of great concern. Given the overall lack of treatment consensus, paucity of literature, and increasing number of augmented breast cancer patients, we provide a retrospective review of the diagnosis, treatment, and follow-up of 12 augmented patients from 1998 to 2004 who developed breast cancer. Eight of 12 augmented patients presented with a palpable mass on physical examination, which prompted further mammographic evaluation. Abnormalities in the remaining four individuals were detected on routine mammographic screening. Pathology staging results were available for all 12 patients. Breast-conserving therapy was used to treat six patients and adequate negative pathologic margins were obtained in all patients. The remaining six patients were treated with mastectomy due to multifocal disease, inadequate margins, or proximity to the implant capsule. Thus far, one patient has had local recurrence and one patient has had distant recurrence after initial surgery. No evidence of local or systemic recurrence, infection, contracture, poor cosmetic outcome, or other complications has been detected in the remaining 10 patients as of the most recent follow-up. Based on this small cohort of augmented women, the presence of implants led to an increased proportion of palpable tumors, in spite of routine screening mammography. Consistent with other studies, although our results suggest a tendency toward delayed diagnosis in augmented women relative to age-matched controls, this did not appear to influence the overall prognosis.
隆乳术正迅速成为最常施行的美容手术之一。然而，随着接受隆胸手术的患者群体老龄化，与乳腺癌筛查、诊断和治疗相关的重大问题日益凸显。尽管目前的证据令人信服地表明乳房植入物不会引发局部或全身性疾病，尤其是乳腺癌，但最近的研究表明，植入物不仅会降低乳房X线摄影的敏感度，还会干扰乳房X线摄影检测，可能导致乳腺癌诊断延迟。此外，对于先前接受过隆胸手术的患者，作为保乳治疗一部分的放射治疗后局部复发的风险，以及不良的美容效果、乳腺纤维化和包膜挛缩等问题，都备受关注。鉴于总体上缺乏治疗共识、文献资料匮乏以及隆胸后患乳腺癌的患者数量不断增加，我们对1998年至2004年期间12例患乳腺癌的隆胸患者的诊断、治疗和随访情况进行了回顾性研究。12例隆胸患者中有8例在体格检查时可触及肿块，这促使进一步进行乳房X线摄影评估。其余4例患者的异常情况是在常规乳房X线摄影筛查中发现的。所有12例患者均有病理分期结果。6例患者采用了保乳治疗，所有患者均获得了足够的阴性病理切缘。其余6例患者因多灶性疾病、切缘不充分或靠近植入物包膜而接受了乳房切除术。迄今为止，1例患者在初次手术后出现了局部复发，1例患者出现了远处复发。截至最近一次随访，其余10例患者未发现局部或全身复发、感染、挛缩、美容效果不佳或其他并发症的迹象。基于这一小群隆胸女性，尽管进行了常规的乳房X线摄影筛查，但植入物的存在导致可触及肿瘤的比例增加。与其他研究一致，虽然我们的结果表明隆胸女性相对于年龄匹配的对照组有延迟诊断的趋势，但这似乎并未影响总体预后。
