Ballester M, Berry Mg, Couturaud B, Reyal F, Salmon R J, Fitoussi A D
Department of Surgery, Institut Curie, Paris, France.
Br J Surg. 2009 Oct;96(10):1141-6. doi: 10.1002/bjs.6696.
Up to 60 per cent of cancers develop laterally in the breast and breast-conserving surgery frequently produces superolateral nipple-areolar complex (NAC) distortion aggravated by postoperative irradiation. Correction is technically demanding and the outcomes are variable. Lateral mammaplasty may allow wider excision margins and prevent such deformities.
This was a review of 86 consecutive patients who had lateral mammaplasty: combined wide tumour excision with NAC repositioning on a reliable dermoglandular pedicle. Simultaneous axillary surgery was performed via a separate or combined incision. Aesthetic outcomes were assessed.
The median age of the women was 54 (range 29-75) years; 55 (64 per cent) had palpable tumours and 73 (85 per cent) underwent simultaneous axillary surgery. Median radiological and histological tumour sizes were 29.8 and 33.6 mm, respectively, and median weight of excised tumour was 150 g. Two patients required haematoma evacuation. Eleven women required revisional surgery for involved or close margins. Aesthetic outcomes were excellent or good in 93 per cent.
Lateral mammaplasty produced clear margins in 87 per cent of women. It is an option when a deformity is anticipated after breast-conserving surgery, and is particularly valuable when neoadjuvant chemotherapy has downgraded a large tumour.
高达60%的乳腺癌在乳房内呈侧向发展，保乳手术常常会导致乳头乳晕复合体（NAC）向乳房外上侧移位，术后放疗会使这种移位加剧。对此进行矫正技术要求高，且效果不一。外侧乳房成形术可能会提供更宽的切除边缘并防止此类畸形。
对86例连续接受外侧乳房成形术的患者进行回顾性研究：即采用可靠的真皮腺体蒂进行广泛肿瘤切除并重新定位NAC。通过单独或联合切口同时进行腋窝手术。评估美学效果。
这些女性的中位年龄为54岁（范围29 - 75岁）；55例（64%）可触及肿瘤，73例（85%）同时接受了腋窝手术。肿瘤的中位影像学大小和组织学大小分别为29.8 mm和33.6 mm，切除肿瘤的中位重量为150 g。2例患者需要进行血肿清除。11例女性因切缘受累或切缘接近而需要进行修复手术。93%的患者美学效果为优或良。
外侧乳房成形术使87%的女性获得了切缘阴性。当预计保乳手术后会出现畸形时，这是一种选择，在新辅助化疗使大肿瘤降级的情况下尤其有价值。
