Munhoz Alexandre Mendonça, Filassi José Roberto, Aldrighi Claudia, Ricci Marcos Desidério, Martella Eduardo, de Barros Alfredo Carlos, Gemperli Rolf, Ferreira Marcus Castro
Department of Plastic Surgery, University of São Paulo and Hospital Sírio-Libanês, São Paulo, Rua da Consolação 3605 ap 91, 01416-001, Sao Paulo, SP, Brazil.
Aesthetic Plast Surg. 2007 Jan-Feb;31(1):94-100. doi: 10.1007/s00266-006-0200-y.
Breast conservation surgery and postoperative radiotherapy are widely accepted as the treatment of choice for patients with early breast cancer. Despite its oncologic benefits, the radiotherapy may cause unpredictable outcomes in soft tissues, especially in patients undergoing breast reconstruction. Described recently, intraoperative irradiation (IORT) has been indicated for selected patients as an alternative to radiotherapy with fewer adverse local effects. Clinical use of reduction mammaplasty (RM) techniques in oncologic breast surgery has been described previously. However, no previous studies have mentioned its application after breast conservation surgery and IORT.
The authors used RM to reconstruct a partial breast tissue defect secondary to breast conservation surgery followed by IORT treatment in a 46-year-old patient with an 11-mm invasive ductal carcinoma between the superior internal quadrants of the right breast.
Satisfactory breast volume and shape were achieved, and no immediate or late complications were observed. After 2 postoperative years, no evidence of fat necrosis, tumor recurrence, or tissue volume loss was observed.
The initial data indicate that RM in the setting of breast conservation surgery reconstruction and IORT is feasible. With appropriate patient selection, respecting indications and limitations, RM has its place among the various reconstructive techniques. Additional studies with larger clinical series and longer follow-up periods are necessary to analyze the precise IORT effects in patients submitted to immediate breast conservation surgery reconstruction.
保乳手术和术后放疗被广泛认为是早期乳腺癌患者的首选治疗方法。尽管放疗具有肿瘤学益处，但它可能会在软组织中导致不可预测的结果，尤其是在接受乳房重建的患者中。最近描述的术中放疗（IORT）已被推荐用于特定患者，作为局部不良反应较少的放疗替代方法。肿瘤性乳房手术中缩乳术（RM）技术的临床应用此前已有描述。然而，以前没有研究提及过其在保乳手术和IORT后的应用。
作者使用RM对一名46岁患有11毫米浸润性导管癌的患者进行右乳内上象限保乳手术后继发的部分乳房组织缺损进行重建，随后进行IORT治疗。
实现了令人满意的乳房体积和形状，未观察到即刻或晚期并发症。术后2年，未观察到脂肪坏死、肿瘤复发或组织体积丢失的迹象。
初步数据表明，RM在保乳手术重建和IORT中的应用是可行的。通过适当的患者选择，尊重适应症和局限性，RM在各种重建技术中占有一席之地。需要进行更多具有更大临床系列和更长随访期的研究，以分析即刻保乳手术重建患者中IORT的确切效果。
