Department of Surgery, National University of Ireland, Clinical Science Institute, Galway, Ireland.
Eur J Surg Oncol. 2011 Nov;37(11):937-43. doi: 10.1016/j.ejso.2011.08.126. Epub 2011 Sep 6.
Historically breast cancer surgery was associated with significant psychosocial morbidity and suboptimal cosmetic outcome. Recent emphasis on women's quality of life following breast cancer treatment has drawn attention to the importance of aesthetic outcome and potential benefits of immediate breast reconstruction (IBR). Our primary aim was to assess patient's quality of life after IBR, compared to a matched group undergoing breast conservation. We also investigated the oncological safety and morbidity associated with immediate reconstruction.
A prospectively collected database of all breast cancer patients who underwent IBR at a tertiary referral breast unit was reviewed. Patients were reviewed clinically, and administered two validated quality of life questionnaires, at least one year after completing their treatment.
255 patients underwent IBR following mastectomy over a 55 month period. Reconstruction with ipsilateral latissimus dorsi flap was most commonly performed (88%). After mean follow-up of 36 months, IBR patients' quality of life was comparable to a group of age-matched women (n = 160) who underwent breast conserving surgery (p = 0.89). No patient experienced local recurrence (0%), distant metastases developed in 4.8% and disease related mortality was 2.2%. Post-operative morbidities included wound infection (11.8%), chronic pain (2.0%), capsular contracture (11%; 36% of whom had radiotherapy) and fat necrosis (14.1%). No patient experienced flap loss.
IBR is a highly acceptable form of treatment for women requiring mastectomy. With high rates of patient satisfaction, low associated morbidity, and proven oncological safety, it is an appropriate recommendation for all women requiring mastectomy.
历史上，乳腺癌手术与显著的社会心理发病率和不理想的美容效果相关。最近，乳腺癌治疗后对女性生活质量的重视，使人们注意到美容效果的重要性以及即刻乳房重建（IBR）的潜在益处。我们的主要目的是评估 IBR 患者与接受保乳手术的匹配组相比的生活质量。我们还调查了即刻重建相关的肿瘤安全性和发病率。
回顾性收集在一家三级转诊乳房中心接受 IBR 的所有乳腺癌患者的前瞻性数据库。在完成治疗至少一年后，对患者进行临床检查，并使用两种经过验证的生活质量问卷进行评估。
在 55 个月的时间内，255 例患者接受了乳房切除术加 IBR。最常进行的重建方式是同侧背阔肌皮瓣（88%）。在平均 36 个月的随访后，IBR 患者的生活质量与接受保乳手术的年龄匹配组（n=160）相当（p=0.89）。没有患者发生局部复发（0%），远处转移发生率为 4.8%，疾病相关死亡率为 2.2%。术后并发症包括伤口感染（11.8%）、慢性疼痛（2.0%）、包膜挛缩（11%；其中 36%接受了放射治疗）和脂肪坏死（14.1%）。没有患者发生皮瓣坏死。
IBR 是需要接受乳房切除术的女性高度可接受的治疗方式。IBR 具有较高的患者满意度、较低的相关发病率和经证实的肿瘤安全性，因此，它是所有需要接受乳房切除术的女性的适当推荐。
