Department of Surgery, Victoria Infirmary, Southern General Hospital, Glasgow, UK.
Br J Surg. 2012 Jun;99(6):799-806. doi: 10.1002/bjs.8704. Epub 2012 Feb 24.
The oncological safety of skin-sparing mastectomy (SSM) followed by immediate breast reconstruction (IBR) is debated owing to a presumed compromise in the completeness of mastectomy. Current evidence is poor as it is based mostly on short-term follow-up data from highly selected patients.
A prospectively maintained institutional database was searched to identify patients who underwent SSM and IBR between 1995 and 2000. A retrospective review of medical records was carried out, including only patients with ductal carcinoma in situ and invasive breast cancer. During this time all patients treated with mastectomy were offered IBR regardless of tumour stage.
Follow-up data from 253 consecutive patients with IBR were reviewed. Patients with incomplete follow-up data and those undergoing SSM for recurrent disease following previous lumpectomy were disregarded, leaving 207 for analysis. Offering IBR to all women requiring mastectomy resulted in a large proportion of patients with advanced disease. During a median follow-up of 119 months, 17 (8·2 per cent) locoregional, six (2·9 per cent) local and 22 (10·6 per cent) distant recurrences were detected; the overall recurrence rate was 39 (18·8 per cent). Overall recurrence rate was associated with axillary lymph node metastasis (P = 0·009), higher stage (P < 0·001) and higher tumour grade (P = 0·031). The breast cancer-specific survival rate was 90·8 per cent (19 of 207 women died from recurrence).
Based on these long-term follow-up data, SSM combined with IBR is an oncologically safe treatment option regardless of tumour stage.
由于假定乳房切除术（SSM）的完整性受到影响，因此对保留皮肤的乳房切除术（SSM）后即刻乳房重建（IBR）的肿瘤安全性存在争议。由于主要基于高度选择的患者的短期随访数据，因此目前的证据较差。
通过搜索前瞻性维护的机构数据库，确定了 1995 年至 2000 年期间接受 SSM 和 IBR 的患者。对病历进行了回顾性审查，仅包括原位导管癌和浸润性乳腺癌患者。在此期间，所有接受乳房切除术的患者均提供了 IBR，而与肿瘤分期无关。
对 253 例接受 IBR 的连续患者的随访数据进行了审查。忽略了随访数据不完整的患者和因先前保乳术复发而接受 SSM 的患者，仅对 207 例患者进行了分析。为所有需要乳房切除术的女性提供 IBR 导致了很大一部分患者患有晚期疾病。在中位随访 119 个月期间，发现 17 例（8.2％）局部区域，6 例（2.9％）局部和 22 例（10.6％）远处复发；总体复发率为 39 例（18.8％）。总体复发率与腋窝淋巴结转移（P = 0.009），较高的分期（P <0.001）和较高的肿瘤分级（P = 0.031）相关。乳腺癌特异性生存率为 90.8％（207 名女性中有 19 名死于复发）。
根据这些长期随访数据，SSM 联合 IBR 是一种肿瘤安全性的治疗选择，与肿瘤分期无关。
