Santanelli F, Paolini G, Campanale A, Longo B, Amanti C
Plastic Surgery Unit, Sant'Andrea Hospital, II School of Medicine, University of Rome La Sapienza, Rome, Italy.
Ann Surg Oncol. 2009 May;16(5):1122-7. doi: 10.1245/s10434-009-0358-z. Epub 2009 Feb 28.
Quadrantectomy is an oncological safe procedure for early breast cancer, but it often results in poor aesthetic results such as breast shape deformity, more visible if the tumor is located in the upper pole. We suggest the use of a modified Wise-pattern breast reduction in patients with moderate to severe breast hypertrophy and tumor located in upper quadrants that keeps the oncological advantages of the quadrantectomy but with better aesthetical results.
Quadrantectomy of the upper quadrant, immediate breast reconstruction and contralateral breast reduction to obtain symmetry was performed on 11 patients affected by early breast cancer with bra cup size from C to E. To replace the skin area removed with mastectomy from the upper quadrants, a similar-size area from the lower pole was preserved.
All patients healed uneventfully within 15 days, and no local or distant recurrences occurred with mean follow-up of 26.5 months (range 19-39 months). In all cases natural breast shape was achieved. The scars were similar to a reduction mammaplasty, and the medial or lateral scar on the upper quadrant did not aesthetically disfigure the décolleté.
Modified Wise-pattern reduction mammaplasty is a valid technique as immediate breast reconstruction to obtain a natural breast mound after upper quadrantectomies on patients with medium/large breasts.
象限切除术对于早期乳腺癌而言是一种肿瘤学上安全的手术方式，但它常常导致不佳的美学效果，如乳房形状畸形，若肿瘤位于上象限则更为明显。我们建议，对于中度至重度乳房肥大且肿瘤位于上象限的患者，采用改良的 Wise 模式乳房缩小术，该术式既能保留象限切除术在肿瘤学方面的优势，又能获得更好的美学效果。
对 11 例罩杯尺寸为 C 至 E 级的早期乳腺癌患者实施上象限象限切除术、即刻乳房重建以及对侧乳房缩小术以实现对称。为了替代上象限乳房切除术切除的皮肤区域，保留了来自下极的相似大小区域。
所有患者均在 15 天内顺利愈合，平均随访 26.5 个月（范围 19 - 39 个月）期间未发生局部或远处复发。所有病例均实现了自然的乳房形状。瘢痕与乳房缩小成形术相似，上象限的内侧或外侧瘢痕在美学上并未损毁颈部及胸部上方的外观。
改良的 Wise 模式乳房缩小成形术是一种有效的技术，可作为即刻乳房重建术，用于为中/大型乳房患者在上象限切除术后获得自然的乳房隆起。
