Kollias James, Davies Giles, Bochner Melissa A, Gill Peter G
Breast, Endocrine and Surgical Oncology Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
ANZ J Surg. 2008 Apr;78(4):269-72. doi: 10.1111/j.1445-2197.2008.04435.x.
Oncoplastic breast surgery is an integral and fundamental component of the clinical management of breast cancer. The aim of this study was to determine the proportion of oncoplastic and reconstructive breast cancer procedures undertaken within a specialist breast practice.
An audit of breast-related cancer procedures was undertaken for patients with early breast cancer between 1 January 2001 and 31 December 2005, treated at the Royal Adelaide Hospital and in private practice. The proportion of oncoplastic and breast reconstructive procedures was calculated to determine the clinical effects on a specialist breast-surgical practice.
Breast cancer resection procedures accounted for 1514 of 2113 of operations (72%). Most of these (897 of 1514, 59.2%) were wide local excision or re-excision procedures. Total breast reconstruction operations (i.e. autogenous tissue flaps, tissue expander/implant reconstructions) accounted for 251 procedures. Of these, 67 (26.7%) were carried out at the time of simple mastectomy. Contralateral breast procedures (i.e. reduction mammaplasty, mastopexy and augmentation) accounted for 138 procedures and nipple-areola reconstruction/tattoo accounted for 153 procedures. Oncoplastic procedures, such as skin-sparing mastectomy, latissimus dorsi miniflap and therapeutic mammaplasty accounted for 57 of 599 procedures (9.5%). Breast reconstruction and oncoplastic operations accounted for 599 of 2113 procedures (28%).
Specialist breast surgeons trained in breast reconstruction and oncoplastic techniques can expect a substantial proportion of their breast practice to include such operative procedures (28% in this series). Subspecialist training in breast surgery should incorporate experience in breast reconstructive and aesthetic surgery for trainees who wish to practise as specialist breast surgeons in the future.
肿瘤整形乳房手术是乳腺癌临床治疗中不可或缺的基本组成部分。本研究的目的是确定在专科乳房诊疗机构中进行的肿瘤整形和乳房重建手术的比例。
对2001年1月1日至2005年12月31日期间在皇家阿德莱德医院和私人诊所接受治疗的早期乳腺癌患者进行了与乳房相关的癌症手术审计。计算肿瘤整形和乳房重建手术的比例，以确定对专科乳房手术诊疗机构的临床影响。
乳腺癌切除手术占2113例手术中的1514例（72%）。其中大部分（1514例中的897例，59.2%）是广泛局部切除或再次切除手术。全乳房重建手术（即自体组织皮瓣、组织扩张器/植入物重建）占251例手术。其中，67例（26.7%）在单纯乳房切除时进行。对侧乳房手术（即乳房缩小成形术、乳房固定术和隆乳术）占138例手术，乳头乳晕重建/纹身占153例手术。肿瘤整形手术，如保乳乳房切除术、背阔肌小皮瓣和治疗性乳房成形术占599例手术中的57例（9.5%）。乳房重建和肿瘤整形手术占2113例手术中的599例（28%）。
接受过乳房重建和肿瘤整形技术培训的专科乳房外科医生预计其相当一部分乳房手术将包括此类手术操作（本系列中为28%）。对于希望未来成为专科乳房外科医生的学员，乳房外科亚专科培训应纳入乳房重建和美容手术方面的经验。
