Gusenoff Jeffrey A, Koltz Peter F, O'Malley William J, Messing Susan, Chen Rui, Langstein Howard N
Rochester, N.Y. From the Division of Plastic Surgery, Department of Surgery, Department of Biostatistics, and Life after Weight Loss Program, University of Rochester Medical Center.
Plast Reconstr Surg. 2009 Oct;124(4):1025-1032. doi: 10.1097/PRS.0b013e3181b457ea.
Given the increased prevalence of bariatric surgery, a certain number of women will develop breast cancer before or after bariatric intervention. Whether bariatric surgery reduces the risk of breast cancer remains uncertain. Similarly, reconstructive options for these patients and timing of reconstruction relative to their weight loss have not been established.
Patients who underwent bariatric procedures from 1992 to 2007 and were diagnosed with breast cancer from 1988 to 2007 were assessed. Outcome measures included age, body mass indices, timing of cancer diagnosis, type of bariatric procedure, treatment and reconstructive modalities, postoperative complications, and comorbidities.
A total of 2878 women underwent bariatric procedures and 112,085 women had breast cancer diagnoses. Thirty-six women had breast cancer diagnosed before (group I) and 13 after bariatric surgery (group II) (p < 0.001). Group I had a mean age of 49.4 years and mean body mass index of 56.3. One woman underwent unilateral autologous/implant reconstruction followed by bariatric surgery and subsequently required revision. Three women in group II (mean age at diagnosis, 48.3 years; mean pre-weight loss body mass index, 53.5; mean body mass index at diagnosis, 32.9; mean time from bariatric surgery, 33 months; mean follow-up from reconstruction, 18 months) underwent autologous free tissue reconstruction; one required two revisions because of further weight loss.
Complication profiles related to reconstruction may be compounded by timing of bariatric surgery and subsequent weight loss. Further multicenter prospective analysis should aid in assessing cancer risk after weight loss along with timing of reconstruction to optimize outcomes in this population.
鉴于减肥手术的患病率增加，一定数量的女性将在减肥手术干预之前或之后患上乳腺癌。减肥手术是否会降低患乳腺癌的风险仍不确定。同样，这些患者的重建选择以及相对于体重减轻的重建时机尚未确定。
评估了1992年至2007年接受减肥手术且1988年至2007年被诊断患有乳腺癌的患者。结果指标包括年龄、体重指数、癌症诊断时间、减肥手术类型、治疗和重建方式、术后并发症及合并症。
共有2878名女性接受了减肥手术，112085名女性被诊断患有乳腺癌。36名女性在减肥手术前被诊断出患有乳腺癌（第一组），13名在减肥手术后被诊断出患有乳腺癌（第二组）（p<0.001）。第一组的平均年龄为49.4岁，平均体重指数为56.3。一名女性在接受减肥手术前进行了单侧自体/植入物重建，随后需要进行修复。第二组的三名女性（诊断时的平均年龄为48.3岁；体重减轻前的平均体重指数为53.5；诊断时的平均体重指数为32.9；减肥手术后的平均时间为33个月；重建后的平均随访时间为18个月）接受了自体游离组织重建；一名女性因进一步体重减轻需要进行两次修复。
与重建相关的并发症情况可能会因减肥手术的时机和随后的体重减轻而更加复杂。进一步的多中心前瞻性分析应有助于评估减肥后的癌症风险以及重建时机，以优化该人群的治疗效果。
