Paris, France From the Departments of Surgery and Biostatistics, Institut Curie.
Plast Reconstr Surg. 2010 Feb;125(2):454-462. doi: 10.1097/PRS.0b013e3181c82d3e.
Synchronous plastic and oncological surgery is undertaken to improve the security of excision margins and yield high-quality aesthetic outcomes when conventional breast-conserving therapy either anticipates poor results or is not possible.
A total of 540 consecutive patients underwent primary oncoplastic breast surgery for cancer with high tumor-to-breast volume ratios and locations precluding a good aesthetic result with simple tumor excision. A variety of techniques were employed at the Institut Curie between 1986 and 2007, and aesthetic outcomes were assessed on a five-point scale from 1 (excellent) to 5 (poor).
The median age was 52 years (range, 28 to 90 years), and median follow-up was 49 months (6 to 262 months). Median tumor size was 29.1 mm (range, 4 to 100 mm), with most patients (72.3 percent) having a brassiere cup size of B or C. Close or involved margins occurred in 18.9 percent, with mastectomy being necessary in 9.4 percent. A satisfactory aesthetic outcome (ratings of 1 to 3) at 5 years was obtained in 90.3 percent. Five-year overall and distant disease-free survival rates were 92.9 and 87.9 percent, respectively, with local recurrence in 6.8 percent.
With local recurrence and survival rates similar to those for breast-conserving therapy, this series confirms the safety of oncoplastic breast surgery for tumors both high in volume and difficult in location. Highly satisfactory cosmetic outcomes extend the indications for conservative surgery, further reduce the mastectomy rate, and limit adverse aesthetic sequelae.
当传统保乳治疗预计效果不佳或不可行时，同步进行整形和肿瘤外科手术，以提高切除边缘的安全性，并获得高质量的美容效果。
1986 年至 2007 年间，共有 540 例高肿瘤与乳房体积比和位置的连续患者接受了原发性肿瘤整形乳房手术，这些患者单纯进行肿瘤切除无法获得良好的美容效果。在居里研究所采用了多种技术，并使用 1 到 5 分制对美容效果进行评估，1 分为极好，5 分为极差。
中位年龄为 52 岁（范围为 28 至 90 岁），中位随访时间为 49 个月（6 至 262 个月）。中位肿瘤大小为 29.1 毫米（范围为 4 至 100 毫米），大多数患者（72.3%）乳房罩杯尺寸为 B 或 C。切缘接近或受累的发生率为 18.9%，需要行乳房切除术的比例为 9.4%。5 年时获得满意的美容效果（评分 1 至 3）的比例为 90.3%。5 年总生存率和无远处疾病生存率分别为 92.9%和 87.9%，局部复发率为 6.8%。
该系列研究结果表明，与保乳治疗的局部复发率和生存率相似，肿瘤体积大且位置困难的患者行肿瘤整形乳房手术是安全的。高度满意的美容效果扩大了保守手术的适应证，进一步降低了乳房切除术的比率，并限制了不良的美学后果。
