Kronowitz Steven J, Hunt Kelly K, Kuerer Henry M, Strom Eric A, Buchholz Thomas A, Ensor Joe E, Koutz Cindy A, Robb Geoffrey L
Houston, Texas From the Departments of Plastic and Reconstructive Surgery, Surgical Oncology, and Radiation Oncology, The University of Texas M. D. Anderson Cancer Center.
Plast Reconstr Surg. 2007 Dec;120(7):1755-1768. doi: 10.1097/01.prs.0000287130.77835.f6.
The authors previously compared the local tissue rearrangement, breast reduction, and latissimus dorsi flap reconstruction techniques for repairing partial mastectomy defects and showed the benefits of breast reduction.
In this study, the authors focused solely on factors influencing outcome in 41 patients who underwent repair of a partial mastectomy defect using breast reduction.
Tumor location had a significant effect on the design of the parenchymal pedicle (p = 0.05). Most repairs were performed with an inferior pedicle. Fifty percent of the lower outer and central quadrant tumors required an amputative design with a free nipple graft. The complication rates for immediate and delayed repair were 24 and 50 percent, respectively. The superior pedicle was associated with the highest complication rates. Tumors in the upper outer quadrant of the breast were associated with the highest complication rate (35 percent). Ninety percent of patients with planned repairs had a viable nipple-areola complex (p = 0.05) and did not require a free nipple graft. More favorable cosmetic outcomes were achieved using an inferior pedicle; less favorable cosmetic outcomes were achieved for tumors in the upper inner quadrant of the breast. Larger defects did not result in less favorable cosmetic outcomes than smaller defects. Only 7 percent of patients had a positive tumor margin. Five percent of patients developed local breast cancer recurrence after a mean follow-up of 36 months.
The authors provide practical guidelines for repairing a partial mastectomy defect using breast reduction that should minimize the occurrence of complications and optimize the cosmetic outcome.
作者之前比较了局部组织重排、乳房缩小术和背阔肌肌皮瓣重建技术修复部分乳房切除术后缺损的效果，并展示了乳房缩小术的优势。
在本研究中，作者仅关注影响41例采用乳房缩小术修复部分乳房切除术后缺损患者预后的因素。
肿瘤位置对实质蒂的设计有显著影响（p = 0.05）。大多数修复采用下蒂。50%的乳房外下象限和中央象限肿瘤需要采用游离乳头移植的切除性设计。即刻修复和延迟修复的并发症发生率分别为24%和50%。上蒂与最高的并发症发生率相关。乳房外上象限的肿瘤并发症发生率最高（35%）。90%计划进行修复的患者乳头乳晕复合体存活（p = 0.05），无需游离乳头移植。采用下蒂可获得更理想的美容效果；乳房内上象限肿瘤的美容效果较差。较大的缺损与较小的缺损相比，美容效果并不更差。仅7%的患者切缘阳性。平均随访36个月后，5%的患者出现局部乳腺癌复发。
作者提供了使用乳房缩小术修复部分乳房切除术后缺损的实用指南，该指南应能最大限度地减少并发症的发生并优化美容效果。
