Pillarisetti Raghu Ram, Querci Della Rovere Guidubaldo
KIMS-USHALAKSHMI Centre for Breast Diseases, Krishna Institute of Medical Sciences (KIMS), Hyderabad, India.
Indian J Surg. 2012 Jun;74(3):255-63. doi: 10.1007/s12262-012-0590-9. Epub 2012 Jul 1.
Breast Surgery is now a recognized subspecialty of General Surgery abroad with structured training for designated 'Oncoplastic Breast Surgeons'. Oncoplastic Breast surgery is probably one of the most interesting and challenging new developments over the past 20 years. The aims of Oncoplastic surgery are wide local excision of the cancer coupled with partial reconstruction of the defect to achieve a cosmetically acceptable result. Avoidance of mastectomy and consequent reduction of psychological morbidity are the principal goals in the development of various oncoplastic techniques. The use of plastic surgical techniques not only ensures good cosmetic outcome, but also allows the cancer surgeon to remove the tumour with greater volume of surrounding tissue, thus extending the boundaries of breast conserving surgery. Proper patient selection and careful planning after proper radiological and clinical assessment are the two essential prerequisites before undertaking oncoplastic breast surgery. Oncoplastic surgery involves both volume displacement and volume replacement techniques. Some commonly used volume displacement procedures are described in the article. The need for adjustment of contralateral breast should also be anticipated at the time of planning breast conserving surgery, which can be done either at the same time as breast cancer surgery or as a delayed setting.
在国外，乳腺外科现已成为普通外科中一个公认的亚专业领域，针对指定的“肿瘤整形乳腺外科医生”开展了结构化培训。肿瘤整形乳腺手术可能是过去20年来最有趣且最具挑战性的新进展之一。肿瘤整形手术的目的是广泛局部切除癌症，并对缺损进行部分重建，以获得美观上可接受的效果。避免乳房切除术并相应降低心理发病率是各种肿瘤整形技术发展的主要目标。整形外科技术的应用不仅能确保良好的美容效果，还能让癌症外科医生切除更大体积周围组织的肿瘤，从而扩大保乳手术的范围。在进行肿瘤整形乳腺手术之前，合适的患者选择以及在进行适当的放射学和临床评估后进行仔细规划是两个必不可少的先决条件。肿瘤整形手术涉及体积移位和体积置换技术。本文描述了一些常用的体积移位手术方法。在规划保乳手术时，还应预计到对侧乳房调整的必要性，这可以在乳腺癌手术的同时进行，也可以延迟进行。
