Hernanz Fernando, Regaño Sara, Redondo-Figuero Carlos, Orallo Victoria, Erasun Fernando, Gómez-Fleitas Manuel
Hospital Universitario Valdecilla, Breast Unit, University of Cantabria, Avda Valdecilla sn, 39008, Santander, Cantabria, Spain.
World J Surg. 2007 Oct;31(10):1934-40. doi: 10.1007/s00268-007-9196-y.
Oncoplastic breast-conserving surgery satisfies oncologic principles and improves cosmetic outcomes, even when an important breast volume excision is required.
We reviewed 28 patients suffering from breast cancer treated with quadrantectomy and immediate myocutaneous latissimus dorsi flap reconstruction. We evaluated the status of the surgical margins, early complications, and cosmetic outcome. Cosmetic assessment was carried out by a panel made up of three women and one man: a female member of an association against breast cancer, a female general practitioner, a female gynecologic resident, and a male breast-specialized surgeon.
Free margins were obtained in all cases. There were 11 postoperative complications: 9 seromas at the donor site, 1 dehiscence of the back wound, and 1 minor partial flap skin necrosis. Chemotherapy and radiotherapy adjuvant treatment was not compromised. The cosmesis outcome was deemed to be good in 43.75% of the cases and satisfactory in 56.25%. The score for overall cosmesis outcome was 6.92 out of 10. Symmetry and the scar of the reconstructed breast were the most influential criteria in the quantitative assessment of overall cosmetic results.
Partial mastectomy (quadrantectomy) and immediate reconstruction with a myocutaneous latissimus dorsi flap allows extensive resection, which fits oncologic requirements, without serious morbidity and a good cosmetic outcome.
保乳整形手术符合肿瘤学原则，即使需要切除大量乳房组织，也能改善美容效果。
我们回顾了28例接受象限切除术及即刻背阔肌肌皮瓣重建术治疗的乳腺癌患者。我们评估了手术切缘情况、早期并发症及美容效果。美容评估由三名女性和一名男性组成的小组进行：一名乳腺癌防治协会的女性成员、一名女性全科医生、一名女性妇科住院医师和一名男性乳腺专科外科医生。
所有病例均获得切缘阴性。术后有11例并发症：供区9例血清肿、背部伤口1例裂开、皮瓣轻微局部皮肤坏死1例。辅助化疗和放疗未受影响。43.75%的病例美容效果被认为良好，56.25%的病例令人满意。总体美容效果评分在10分制中为6.92分。对称性和重建乳房的瘢痕是总体美容效果定量评估中最具影响力的标准。
部分乳房切除术（象限切除术）及即刻背阔肌肌皮瓣重建术可实现广泛切除，符合肿瘤学要求，且无严重并发症，美容效果良好。
