Chatterjee J S, Lee A, Anderson W, Baker L, Stevenson J H, Dewar J A, Thompson A M
Department of Plastic and Reconstructive Surgery, Ninewells Hospital and Medical School, Dundee, UK.
Br J Surg. 2009 Oct;96(10):1135-40. doi: 10.1002/bjs.6693.
The effect of postoperative radiotherapy following autologous flap breast reconstruction is controversial. The aim of this study was to measure whether adjuvant radiotherapy following immediate deep inferior epigastric perforator (DIEP) free flap breast reconstruction affected flap volume.
Sixty-eight women underwent immediate autologous DIEP flap reconstruction following mastectomy for breast cancer. Twenty-two of the 68 received postoperative radiotherapy (45Gy in 20 fractions over 4 weeks). Intraoperative flap volume data were collected prospectively. Volumetric assessment was carried out a minimum of 1 year after surgery. Patients who had volume adjustment surgery after initial reconstruction were analysed separately.
The mean age of the women was 52 (range 37-69) years and median follow-up was 3.5 (range 1-10) years. There was no statistically significant difference in volume change between patients who had and those who did not have postreconstruction radiotherapy for the whole cohort (median reduction 65 versus 0 ml) or when women who had undergone further volume adjustment surgery were excluded.
In this study postoperative radiotherapy did not significantly affect breast volume after DIEP flap reconstruction. The potential need for postoperative radiotherapy should not deter women from undergoing immediate DIEP flap breast reconstruction.
自体皮瓣乳房重建术后放疗的效果存在争议。本研究的目的是测定即刻腹壁下深动脉穿支（DIEP）游离皮瓣乳房重建术后辅助放疗是否会影响皮瓣体积。
68例女性因乳腺癌行乳房切除术后接受了即刻自体DIEP皮瓣重建。68例中有22例接受了术后放疗（4周内20次分割，共45Gy）。前瞻性收集术中皮瓣体积数据。术后至少1年进行体积评估。对初次重建后进行了体积调整手术的患者单独进行分析。
这些女性的平均年龄为52岁（范围37 - 69岁），中位随访时间为3.5年（范围1 - 10年）。对于整个队列，接受重建后放疗和未接受重建后放疗的患者之间，体积变化无统计学显著差异（中位减少量分别为65 ml和0 ml）；排除接受了进一步体积调整手术的女性后，结果亦是如此。
在本研究中，术后放疗对DIEP皮瓣重建后的乳房体积无显著影响。术后放疗的潜在需求不应阻碍女性接受即刻DIEP皮瓣乳房重建。
