Khansa Ibrahim, Boehmler James H
Department of Plastic Surgery, The Ohio State University Wexner Medial Center, Columbus, OH.
Microsurgery. 2015 Jan;35(1):21-8. doi: 10.1002/micr.22225. Epub 2014 Jan 21.
In women with early-stage breast cancer, breast-conserving therapy (BCT) provides comparable survival to mastectomy. BCT has the advantage of preserving most of the breast, its skin envelope and the nipple-areola complex. However, deformity may result from the excision of significant amounts of breast tissue, as well as radiation therapy. Several studies have compared patients who underwent BCT to different patients who underwent mastectomy and reconstruction, and found superior aesthetic outcomes in the latter group. Our goal in this study was to compare the aesthetic outcomes in the same women who underwent BCT followed by mastectomy and reconstruction.
Between 2007 and 2012, 42 women with a history of BCT developed cancer recurrence and underwent mastectomy and microsurgical breast reconstruction at our institution. Photographs before and after mastectomy and reconstruction were rated by a panel of nine judges (two independent plastic surgeons, three surgical oncologists, one radiation oncologist, one medical oncologist, and two medical students), using a validated scale
Overall, patients received a significantly higher aesthetic score after mastectomy and reconstruction than after BCT. The greatest areas of aesthetic improvement were breast volume, contour, and projection. Patients whose lumpectomy was in the lower inner quadrant, those undergoing bilateral mastectomy and reconstruction and those completing all stages of their reconstruction had the greatest aesthetic improvement
When advising patients with early-stage breast cancer, the superior aesthetic outcome of mastectomy and microsurgical reconstruction compared to BCT must be weighed against disadvantages such as loss of sensation, length of surgery, and donor-site morbidity.
对于早期乳腺癌女性患者，保乳治疗（BCT）与乳房切除术的生存率相当。保乳治疗的优势在于保留大部分乳房、其皮肤包膜和乳头乳晕复合体。然而，大量乳腺组织切除以及放射治疗可能导致畸形。多项研究比较了接受保乳治疗的患者与接受乳房切除术及重建术的不同患者，发现后一组的美学效果更佳。我们这项研究的目的是比较同一批先接受保乳治疗，随后又接受乳房切除术及重建术的女性患者的美学效果。
2007年至2012年间，42例有保乳治疗史且癌症复发的女性患者在我们机构接受了乳房切除术及显微外科乳房重建术。乳房切除术前和术后重建的照片由一个由九名评委组成的小组（两名独立的整形外科医生、三名外科肿瘤学家、一名放射肿瘤学家、一名医学肿瘤学家和两名医学生）使用经过验证的量表进行评分。
总体而言，患者在乳房切除术后及重建后的美学评分显著高于保乳治疗后。美学改善最显著的方面是乳房体积、轮廓和凸度。肿块切除术位于内下象限的患者、接受双侧乳房切除术及重建术的患者以及完成重建所有阶段的患者美学改善最为明显。
在为早期乳腺癌患者提供建议时，必须权衡乳房切除术及显微外科重建术与保乳治疗相比在美学效果上的优势，以及诸如感觉丧失、手术时间和供区并发症等劣势。
