Department Plastic and Reconstructive Surgery, University of the Witwatersrand, 1 Jan Smuts Avenue, Johannesburg 2001, South Africa.
World J Surg. 2013 Jan;37(1):72-83. doi: 10.1007/s00268-012-1786-7.
Therapeutic mammaplasty (TM) for breast cancer is a widely practiced oncoplastic technique. Patient selection criteria and method of margin assessment are not clearly established. The aim of our review was to analyse oncological and aesthetic outcomes over a 7 year period.
We conducted a retrospective review of 251 breast cancer patients who underwent TM from 2002 to 2009 at the Netcare Breast Care Centre, Johannesburg. Primary chemotherapy was used to downsize large tumours. Intraoperative margin assessment was performed. Statistical analysis was performed using Kaplan-Meier estimates. Cosmetic outcomes were assessed by an independent review panel using photographic material.
Mean tumour size was 15.4 mm. Mean resection weight was 237 g. Sixty-four (25.5 %) patients received primary chemotherapy. Mean margin taken was 15 mm. The back-to-theatre rate was 2 % (5 cases). A total of 222 patients underwent bilateral procedures. Contralateral occult disease was identified in six cases (2.4 %). The early (<2 months) complication rate was 3.2 %. Late complications were related to adjuvant radiotherapy (20.7 %). Mean follow-up was 50 months. The recurrence rate was 4 %. Five of six patients with locoregional recurrence had DCIS at initial surgery. The mortality rate was 3.2 %. The overall survival rate was 96.4 % and the metastasis-free survival rate was 94.6 %. Acceptable aesthetic results were achieved in 96 % of the patients.
Primary chemotherapy allowed for TM in patients with large tumours. Intraoperative margin assessment decreased reoperation rate. Contralateral matching procedures resulted in histological detection of occult disease. TM is an oncologically appropriate and cosmetically favourable technique.
乳腺癌的治疗性乳房成形术（TM）是一种广泛应用的肿瘤整形技术。患者选择标准和切缘评估方法尚未明确确立。我们的研究目的是分析 7 年期间的肿瘤学和美学结果。
我们对 2002 年至 2009 年在约翰内斯堡 Netcare 乳房护理中心接受 TM 的 251 例乳腺癌患者进行了回顾性研究。主要化疗用于缩小大肿瘤。术中进行了切缘评估。使用 Kaplan-Meier 估计进行统计分析。使用照片材料由独立评审小组评估美容结果。
平均肿瘤大小为 15.4 毫米。平均切除重量为 237 克。64 例（25.5%）患者接受了主要化疗。平均切除宽度为 15 毫米。返回手术室的比率为 2%（5 例）。共有 222 例患者接受了双侧手术。在 6 例（2.4%）中发现了对侧隐匿性疾病。早期（<2 个月）并发症发生率为 3.2%。晚期并发症与辅助放疗有关（20.7%）。平均随访时间为 50 个月。复发率为 4%。局部区域复发的 5 例患者中，初次手术时均有 DCIS。死亡率为 3.2%。总生存率为 96.4%，无转移生存率为 94.6%。96%的患者获得了可接受的美容效果。
主要化疗使 TM 适用于大肿瘤患者。术中切缘评估降低了再次手术率。对侧匹配程序导致隐匿性疾病的组织学检测。TM 是一种肿瘤学上合适且美容效果良好的技术。
