Patani N, Devalia H, Anderson A, Mokbel K
The London Breast Institute, The Princess Grace Hospital, London, UK.
Surg Oncol. 2008 Aug;17(2):97-105. doi: 10.1016/j.suronc.2007.11.004. Epub 2008 Feb 21.
The management of early breast cancer with skin-sparing mastectomy (SSM) and immediate breast reconstruction (IBR) is not based on evidence from randomised controlled trials. The purpose of this study is to evaluate the oncological safety, post-operative morbidity and patients' satisfaction with SSM and IBR using the latissimus dorsi (LD) myocutaneous flap and/or breast prosthesis.
Eighty-three consecutive women underwent 93 SSMs with IBR (10 bilateral), using the LD flap plus implant (n=55) or implant alone (n=38), indications included early breast cancer and prophylaxis due to BRCA-1 gene mutation. Nipple reconstruction was performed in 38 patients, using the trefoil local flap technique, nipple sharing or Monocryl mesh. Twenty-three underwent contra-lateral surgery in order to optimise symmetry, including 15 augmentations and eight mastopexy/reduction mammoplasties. Patient satisfaction with the outcome of surgery was assessed on a linear visual analogue scale ranging from 0 (not satisfied) to 10 (most satisfied).
There was no local recurrence (LR) after a median follow-up of 34 months (range=3-79 months). Overall survival was 98.8%, three patients developed distant disease and one patient died of metastatic breast cancer. No case of partial or total LD flap loss was observed. Morbidities included infection, requiring implant removal in two patients and one patient developed marginal ischaemia of the skin envelope. Significant capsule formation, requiring capsulotomy, was observed in 87% of patients who had either PMR or prior RT compared with 13% for those who did not have RT. Sixty-one (73.5%) of 83 patients completed the questionnaire with a median and mean satisfaction scores of 10.0 and 9.3, respectively (range=6-10).
SSM with IBR is associated with low morbidity, high levels of patient satisfaction and is oncologically adequate for T(is), T1 and T2 tumours without extensive skin involvement.
保留皮肤的乳房切除术（SSM）和即刻乳房重建术（IBR）治疗早期乳腺癌并非基于随机对照试验的证据。本研究的目的是评估采用背阔肌（LD）肌皮瓣和/或乳房假体进行SSM和IBR的肿瘤学安全性、术后发病率以及患者满意度。
83例连续女性接受了93例SSM联合IBR手术（10例双侧），采用LD瓣加植入物（n = 55）或单纯植入物（n = 38），适应症包括早期乳腺癌和因BRCA - 1基因突变进行的预防性手术。38例患者进行了乳头重建，采用三叶局部皮瓣技术、乳头共享或聚乙醇酸网片。23例患者接受了对侧手术以优化对称性，包括15例隆乳术和8例乳房上提术/缩乳术。采用线性视觉模拟量表评估患者对手术结果的满意度，范围从0（不满意）到10（最满意）。
中位随访34个月（范围 = 3 - 79个月）后无局部复发（LR）。总生存率为98.8%，3例患者发生远处转移，1例患者死于转移性乳腺癌。未观察到LD瓣部分或全部丢失的病例。并发症包括感染，2例患者需要取出植入物，1例患者出现皮肤包膜边缘缺血。与未接受放疗者的13%相比，接受过保乳放疗（PMR）或既往放疗的患者中有87%观察到显著的包膜形成，需要进行包膜切开术。83例患者中有61例（73.5%）完成了问卷调查，中位满意度得分和平均满意度得分分别为10.0和9.3（范围 = 6 - 10）。
SSM联合IBR发病率低、患者满意度高，对于无广泛皮肤受累的Tis、T1和T2肿瘤在肿瘤学上是合适的。
