Sarkar Diptendra Kumar, Maji Abhiram, Saha Sujitesh, Biswas Jayanta Kumar
Indian J Surg Oncol. 2011 Jun;2(2):112-7. doi: 10.1007/s13193-011-0065-7. Epub 2011 Apr 22.
Oncoplastic breast surgery is the fusion of oncological and surgical principles to gain successful breast tumour excision with good cosmesis. It is an widely accepted and popular method in the western world. However, the picture is different in India. The major issues here, like late detection and advanced tumours, poor socio-economic status overriding quality of life issue and shortage of dedicated oncoplastic surgeons result in a poor acceptance and practice of oncoplastic breast surgery. This article explores the use of various oncoplastic techniques in clinical practice and discusses future directions in this emerging field in an Indian perspective. In our institute (breast care unit, I.P.G.M.E&R,Kolkata), we performed a retrospective study over a period of five years (2005-2009). It included a sample size of 30 patients with diagnosed breast cancer or Phylloides Tumor (PT). The study focused on the indications, type of oncoplastic procedure used, cosmetic outcome (shape / volume replacement, ptosis correction & chest wall coverage), complications faced and response to subsequent therapy. The indications, for which oncoplastic techniques were applied, were DCIS (2), LCIS (1), IDC (19) and phylloides tumor (8). Of the 30 patients, RAT was used in 8, LDMF (of various types and volume) was used in 16, pedicled TRAM flap was used in 3 and reduction mastopexy in 3.The procedural indications of reconstruction were total glandular replacement by TRAM flap, mini-LDMF to fill volume loss after BCS or wide local excision, rotation advancement technique for reshaping / symmetry maintenance after BCS or wide local excision, LDMF for chest wall coverage after MRM and reduction mastopexy after wide local excision. From patient's point of view the outcome of surgery was highly satisfactory (score 3 or more) in 19 out of 30 patients (63.33%). LDMF was the most commonly used (16 out of 30) oncoplastic procedure with least complication rates (0 out of 16). 4 out of 30 patients had complications related to the procedure. Chest wall coverage after MRM still forms the main indication of oncoplastic surgery in this country.
肿瘤整形乳房手术是肿瘤学和外科学原则的融合，旨在成功切除乳腺肿瘤并获得良好的美容效果。它在西方世界是一种广泛接受且流行的方法。然而，在印度情况却有所不同。这里的主要问题，如检测延迟和肿瘤进展、社会经济地位低下优先于生活质量问题以及缺乏专业的肿瘤整形外科医生，导致肿瘤整形乳房手术的接受度和应用情况不佳。本文从印度的视角探讨了各种肿瘤整形技术在临床实践中的应用，并讨论了这一新兴领域的未来发展方向。在我们研究所（加尔各答IPGME&R乳腺护理单元），我们进行了一项为期五年（2005 - 2009年）的回顾性研究。研究样本包括30例确诊为乳腺癌或叶状肿瘤（PT）的患者。该研究聚焦于手术指征、所采用的肿瘤整形手术类型、美容效果（形状/体积替代、乳房下垂矫正及胸壁覆盖）、所面临的并发症以及对后续治疗的反应。应用肿瘤整形技术的指征包括导管原位癌（DCIS，2例）、小叶原位癌（LCIS，1例）、浸润性导管癌（IDC，19例）和叶状肿瘤（8例）。在这30例患者中，8例采用了保留乳头乳晕的乳房切除术（RAT），16例采用了不同类型和体积的局部背阔肌肌皮瓣（LDMF），3例采用了带蒂腹直肌肌皮瓣（TRAM瓣），3例采用了乳房缩小上提术。重建的手术指征包括用TRAM瓣进行全腺体替代、用迷你LDMF填充保乳手术（BCS）或广泛局部切除术后的体积缺失、在BCS或广泛局部切除术后采用旋转推进技术进行塑形/维持对称、在乳房改良根治术（MRM）后用LDMF覆盖胸壁以及在广泛局部切除术后进行乳房缩小上提术。从患者角度来看，30例患者中有19例（63.33%）对手术结果非常满意（评分3分及以上）。LDMF是最常用的（30例中有16例）肿瘤整形手术，并发症发生率最低（16例中0例）。30例患者中有4例出现了与手术相关的并发症。在这个国家，MRM后的胸壁覆盖仍然是肿瘤整形手术的主要指征。
