Division of Surgical Oncology, Department of Surgery, Institute for Breast Health, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
Ann Surg Oncol. 2010 Dec;17(12):3247-51. doi: 10.1245/s10434-010-1140-y. Epub 2010 Jun 12.
Oncoplastic mastopexy has been popularized as a method to hide the cosmetic effects of central or large-volume resections associated with breast conservation surgery for breast cancer.
This review was undertaken to study the uses and limitations of these techniques in providing adequate breast conservation lumpectomy for breast cancer of any stage in a single surgeon's practice. A review of breast cancer cases March 2004 through December 2009 were analyzed for the use of oncoplastic reconstruction in breast conservation surgery.
A total of 167 patients had lumpectomies during this period associated with oncoplastic mastopexy reconstruction. The average age was 55.6 years with a range of 33-85 years. Stage 0 breast cancer accounted for 33 cases (19.8%), and 134 cases were invasive cancers stages 1-3 (stage 1, 34.1%; stage 2, 30.6%; and stage 3, 15.6%). The most common oncoplastic techniques used were, in order of frequency: batwing mastopexy, parallelogram mastopexy, and Modified Wise pattern mastopexy. Positive or close margins (≤ 2 mm) were present in 37 of 167 cases (22%). Positive margins were most associated with higher stage, positive nodes, positive lymphovascular invasion (LVI), use of neoadjuvant chemotherapy, and larger initial T stage, positive estrogen receptor (ER), and younger age. Of these higher stage, node positive, and use of neoadjuvant chemotherapy were statistically significant in this small series (P values = 0.034, 0.016, and 0.022, respectively). Ki-67 and HER2 status were not associated with positive margins. Positive margins were manageable by local re-excision of a solitary face of the prior resection wall in more than 2/3 of cases to achieve negative pathologic margins. Only 11 of 167 required mastectomy because of failure to achieve adequate margins for oncologic control.
Oncoplastic mastopexy allows the surgeon to address large tumors or tumors in cosmetically difficult sites adequately for breast conservation. Careful margin marking and re-excision of close or positive margins is still often feasible to achieve adequate negative margin with acceptable cosmesis in spite of the large initial volumes of resection.
肿瘤整形乳房悬吊术已被广泛应用于乳腺癌保乳手术中，用于隐藏中央或大容量切除的美容效果。
本研究旨在探讨这些技术在一位外科医生的实践中，为任何阶段的乳腺癌提供足够的保乳切除术的用途和局限性。对 2004 年 3 月至 2009 年 12 月期间的乳腺癌病例进行了回顾性分析，以研究在保乳手术中使用肿瘤整形重建的情况。
在此期间，共有 167 例患者接受了乳房切除术联合肿瘤整形乳房悬吊术重建。平均年龄为 55.6 岁，范围为 33-85 岁。0 期乳腺癌占 33 例（19.8%），134 例为 1-3 期浸润性癌（1 期，34.1%；2 期，30.6%；3 期，15.6%）。最常用的肿瘤整形技术依次为蝙蝠翼乳房悬吊术、平行四边形乳房悬吊术和改良 Wise 模式乳房悬吊术。167 例中有 37 例（22%）切缘阳性或接近（≤2mm）。阳性切缘与较高的分期、阳性淋巴结、阳性脉管内浸润（LVI）、新辅助化疗的使用以及较大的初始 T 分期、阳性雌激素受体（ER）和较年轻的年龄有关。在这个小系列中，较高的分期、阳性淋巴结和新辅助化疗的使用具有统计学意义（P 值分别为 0.034、0.016 和 0.022）。Ki-67 和 HER2 状态与阳性切缘无关。在超过 2/3 的病例中，通过对先前切除壁的单个面进行局部再次切除，可以处理阳性切缘，以获得阴性病理切缘。只有 11 例患者（167 例中的 11 例）因未能达到足够的肿瘤控制切缘而需要乳房切除术。
肿瘤整形乳房悬吊术使外科医生能够为保乳手术充分处理大肿瘤或美容困难部位的肿瘤。尽管切除的初始体积较大，但仍能通过仔细的切缘标记和对接近或阳性切缘的再次切除，在可接受的美容效果下，实现足够的阴性切缘。
