Sorin T, Fyad J-P, Pujo J, Colson T, Bordes V, Leroux A, Marchal F, Brix M, Simon E, Verhaeghe J-L, Classe J-M, Dolivet G
Institut de cancérologie de Lorraine-Alexis-Vautrin, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France; Service de chirurgie plastique et maxillo-faciale, hôpital Central, CHU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France.
Institut de cancérologie de Lorraine-Alexis-Vautrin, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France.
Ann Chir Plast Esthet. 2014 Apr;59(2):e21-8. doi: 10.1016/j.anplas.2013.12.007. Epub 2014 Feb 13.
Breast carcinomas are the most frequent form of cancer in French women. Following a total mastectomy, only an estimated 25% of patients wish to undergo breast reconstruction. After mammary volume reconstitution, the plastic surgeon often attempts to harmonize the two breasts by carrying out contralateral reduction mammaplasty (CRM). In the literature, the incidence of occult contralateral carcinomas incidentally discovered in surgical specimens ranges from 1.12 to 4.5%. The main objective of this study was to evaluate occurrence of carcinoma in the CRM specimens in the framework of a breast reconstruction operation. The secondary objective was to determine the consequences of the incidentally discovered carcinoma in the contralateral breast.
This was a 6-year, bicentric, retrospective study involving women having undergone breast cancer surgery who later underwent contralateral reduction mammaplasty (CRM), that is to say reconstruction aimed at harmonization of the two breasts.
Three hundred and nineteen patients were included in the study. Mean age during the CRM was 55years (29-79). Mean weight of the surgical specimens was 323grams (12-2500). Incidence of occult carcinomas found in the specimens was 0.94% (3 patients). The mean age for these 3 cases was 58years (47-64). All 3 patients had superior pedicle mammaplasty. One of the patients benefited from monobloc resection with orientation of the surgical specimen. In the other 2 cases, there existed 3 surgical resection specimens; in one case, they were oriented; in the other, they were not. In all 3 cases, the histological findings were unifocal ductal carcinomas in situ (DCIS). Mean tumor size was 5.7mm (3-9). Only the patient having had monobloc resection with orientation of the specimen underwent salvage surgery, which consisted in partial mastectomy, otherwise known as secondary lumpectomy. Adjuvant radiotherapy was administered to all of the patients. After 17months of mean follow-up (12-22), no recurrence was found in any of the three cases.
Incidence of occult contralateral breast carcinomas after symmetrization CRM approximates 1%. Our observations are in agreement with the data in the literature. Incidence is greater than in mammaplasty carried out for esthetic or functional reasons; this is probably due to the higher age and the previous breast cancer history of the breast reconstruction population. Monobloc resection and orientation of the surgical specimens with surgeon's knots facilitate precise pinpointing of the occult carcinoma. A secondary lumpectomy may take place when margins of excision are invaded or inadequate.
乳腺癌是法国女性中最常见的癌症形式。在全乳切除术后，估计只有25%的患者希望进行乳房重建。在恢复乳房体积后，整形外科医生通常会尝试通过对侧乳房缩小成形术（CRM）来使两侧乳房协调一致。在文献中，手术标本中偶然发现的隐匿性对侧癌的发生率在1.12%至4.5%之间。本研究的主要目的是评估在乳房重建手术框架下CRM标本中癌的发生情况。次要目的是确定对侧乳房中偶然发现的癌的后果。
这是一项为期6年的双中心回顾性研究，涉及接受过乳腺癌手术且后来接受对侧乳房缩小成形术（CRM）的女性，即旨在使两侧乳房协调一致的重建手术。
319名患者纳入研究。CRM期间的平均年龄为55岁（29 - 79岁）。手术标本的平均重量为323克（12 - 2500克）。标本中隐匿性癌的发生率为0.94%（3例患者）。这3例患者的平均年龄为58岁（47 - 64岁）。所有3例患者均接受了上蒂乳房成形术。其中1例患者受益于整块切除并对手术标本进行了定向。在另外2例中，有3个手术切除标本；1例进行了定向，另1例未定向。所有3例的组织学结果均为单灶性导管原位癌（DCIS）。平均肿瘤大小为5.7毫米（3 - 9毫米）。只有接受了整块切除并对标本进行定向的患者接受了挽救性手术，即部分乳房切除术，也就是二次肿块切除术。所有患者均接受了辅助放疗。在平均随访17个月（12 - 22个月）后，3例患者均未发现复发。
对称化CRM术后隐匿性对侧乳腺癌的发生率约为1%。我们的观察结果与文献数据一致。该发生率高于因美容或功能原因进行的乳房成形术；这可能是由于乳房重建人群年龄较大且有乳腺癌病史。整块切除并使用外科结对手术标本进行定向有助于精确确定隐匿性癌的位置。当切除边缘受侵或不足时可进行二次肿块切除术。
