Plastic and Reconstructive Surgery Department, University of Udine, Gemona del Friuli, Udine, Italy.
Breast. 2013 Oct;22(5):946-51. doi: 10.1016/j.breast.2013.05.008. Epub 2013 Jul 9.
During the past 20 years, breast conservation has become the preferred treatment modality for breast carcinoma, and in recent times there is an increased expectation from breast cancer patients to retain their "normal breast appearance". For large tumor-to-breast ratio excision, the subspecialty of oncoplastic surgery is born, helping to achieve a good oncologic and esthetic result. In our study we have considered 767 patients undergone a mastectomy or quadrantectomy, and especially 489 undergone quadrantectomy. We have used our protocol for breast reshaping and analyzed our data in terms of oncologic safety and esthetic results. Considering the lesions, they were placed like this: 214 (44%) in the SEQ, 58 lesions (12%) in the SIQ, 54 lesions (11%) in the IEQ, 24 lesions (5%) in the IIQ, 45 lesions (9%) respectively in the CQ and between the SQ, 39 lesions (8%) between the EQ, 5 lesions (1%) respectively between the internal quadrants and between the inferior quadrants. We have chosen simple breast reshapings in case of operations on the superior quadrants, while, in case of operations on the inferior quadrants, we have chosen complex techniques, like reshapings according to a "key hole" reductive mammaplasty, which requires also a contralateral reshaping. We have done simple and monolateral reshapings respectively in 372 (76%) and 296 (60.5%) cases. We have had early complications in 98 (20%) cases: 12 infections (2.4%), 10 hematomas (2%), 11 seromas (2.2%), 65 liponecrosis. As late complications, we have found scar retractions and minus areas in 20 cases (4.08%), while we have found asymmetries and bigger deformities in 34 cases (6.95%). We have not found any cancer relapse after one year of follow up, while we have had 3 cases of relapse (0.6%) after 5 years of follow up, respectively after 5, 4 and 2 years. This result has to be attributed to our preoperatory project of surgery derived from many factors, among which stands out the MRI done in all the cases. We think that an immediate breast reshaping following quadrantectomy is the best esthetic and psychologic option for breast cancer patients.
在过去的 20 年中，保乳治疗已成为乳腺癌的首选治疗方式，最近乳腺癌患者对保留“正常乳房外观”的期望也越来越高。对于肿瘤与乳房比例较大的切除，肿瘤整形手术应运而生，有助于实现良好的肿瘤学和美学效果。在我们的研究中，我们考虑了 767 例接受乳房切除术或象限切除术的患者，其中 489 例接受象限切除术。我们使用了我们的乳房重塑方案，并根据肿瘤学安全性和美学效果分析了我们的数据。考虑到病变，它们的位置如下：214 个（44%）位于 SEQ，58 个（12%）位于 SIQ，54 个（11%）位于 IEQ，24 个（5%）位于 IIQ，45 个（9%）分别位于 CQ 和 SQ 之间，39 个（8%）位于 EQ 之间，5 个（1%）分别位于内象限之间和下象限之间。我们选择了简单的乳房重塑术用于上象限的手术，而对于下象限的手术，我们选择了复杂的技术，例如根据“钥匙孔”缩小性乳房成形术进行的重塑术，这也需要对侧乳房的重塑术。我们分别在 372 例（76%）和 296 例（60.5%）病例中进行了简单的单侧重塑术。我们有 98 例（20%）早期并发症：12 例感染（2.4%），10 例血肿（2%），11 例血清肿（2.2%），65 例脂肪坏死。作为晚期并发症，我们发现 20 例（4.08%）存在疤痕收缩和缺损区域，而发现 34 例（6.95%）存在不对称和更大的畸形。在一年的随访后，我们没有发现任何癌症复发，而在五年的随访后，我们分别在 5 年、4 年和 2 年后发现了 3 例复发（0.6%）。这一结果归因于我们术前手术计划的多种因素，其中包括所有病例中进行的 MRI。我们认为象限切除术立即进行乳房重塑是乳腺癌患者最佳的美学和心理选择。
