Imahiyerobo Thomas A, Pharmer Lindsay A, Swistel Alexander J, Talmor Mia
From the *Division of Plastic Surgery, and †Department of Surgery, Weill Cornell Medical College, New York, NY.
Ann Plast Surg. 2015 Oct;75(4):370-5. doi: 10.1097/SAP.0000000000000159.
Oncoplastic breast reduction has been shown to be an effective approach to breast conservation surgery in women with macromastia. Clear surgical margins can be achieved while simultaneously improving symptomatic macromastia and enhancing aesthetic outcomes. Little has been written about postoperative complications after this procedure, beyond the risk of locoregional recurrence. This study aimed to compare the complication profile for oncoplastic breast reduction versus reduction for benign macromastia.
A retrospective review of our experience with oncoplastic breast reduction was performed. This represented a consecutive series of 118 patients undergoing bilateral breast reduction during the 7-year study period from March 2005 to March 2012. There were 64 patients identified who underwent oncoplastic breast reduction. Patients were determined to be a good candidate for breast conservation therapy if it was felt that clear surgical margins could be obtained without mastectomy. Postoperative complications (within 6 weeks of surgery) were compared to a control group of 56 patients undergoing reduction for benign macromastia. The associations between complications and potential risk factors were analyzed using logistic regression.
Patients undergoing oncoplastic breast reduction and reduction for benign macromastia had some key differences. In general, macromastia patients were younger (mean age, 42.3 vs 57.5 years; P < 0.001) and had lower body mass index (mean, 26.1 vs 30.6 kg/m2; P < 0.001) compared to those patients having oncoplastic reduction. Within the oncoplastic reduction group, 14 (21.9%) patients had a total of 16 complications; among the benign macromastia group, 9 (16.1%) patients had a total of 10 complications (P = 0.420). On univariate analysis, oncoplastic reduction was not predictive of having a perioperative complication (odds ratio, 1.462; 95% confidence interval, 0.579-3.696; P = 0.422). Body mass index was found to be predictive of having a complication after reduction for either indication (odds ratio, 1.108; 95% confidence interval, 1.018-1.206; P = 0.017). Within the oncoplastic reduction cohort at an average follow-up of 34.6 months (range, 0.3-90.3 months), 5 (7.9%) patients developed locoregional recurrence and 2 patients developed distant metastasis.
Compared with reduction mammoplasty for benign macromastia, a widely accepted procedure, patients undergoing oncoplastic breast reduction were equally likely to have a postoperative complication. Elevated body mass index was shown to be a statistically significant predictor of having a complication after reduction for either indication. Overall complication rates were acceptably low for both procedures.
肿瘤整形性乳房缩小术已被证明是治疗巨乳症女性保乳手术的一种有效方法。在实现切缘阴性的同时，可改善巨乳症的症状并提高美学效果。除了局部区域复发风险外，关于该手术后的术后并发症鲜有报道。本研究旨在比较肿瘤整形性乳房缩小术与良性巨乳症乳房缩小术的并发症情况。
对我们开展肿瘤整形性乳房缩小术的经验进行回顾性研究。这是一组连续的118例患者，在2005年3月至2012年3月的7年研究期间接受了双侧乳房缩小术。其中64例患者接受了肿瘤整形性乳房缩小术。如果认为在不进行乳房切除术的情况下能够获得清晰的手术切缘，则确定患者为保乳治疗的合适人选。将术后并发症（术后6周内）与56例接受良性巨乳症乳房缩小术的对照组患者进行比较。使用逻辑回归分析并发症与潜在风险因素之间的关联。
接受肿瘤整形性乳房缩小术和良性巨乳症乳房缩小术的患者存在一些关键差异。总体而言，与接受肿瘤整形性乳房缩小术的患者相比，巨乳症患者更年轻（平均年龄42.3岁对57.5岁；P<0.001），体重指数更低（平均26.1kg/m²对30.6kg/m²；P<0.001）。在肿瘤整形性乳房缩小术组中，14例（21.9%）患者共有16例并发症；在良性巨乳症组中，9例（16.1%）患者共有10例并发症（P=0.420）。单因素分析显示，肿瘤整形性乳房缩小术不能预测围手术期并发症（优势比，1.462；95%置信区间，0.579-3.696；P=0.422）。发现体重指数可预测两种手术指征的乳房缩小术后发生并发症（优势比，1.108；95%置信区间，1.018-1.206；P=0.017）。在肿瘤整形性乳房缩小术队列中，平均随访34.6个月（范围0.3-90.3个月），5例（7.9%）患者发生局部区域复发，2例患者发生远处转移。
与广泛接受的良性巨乳症乳房缩小术相比，接受肿瘤整形性乳房缩小术的患者术后发生并发症的可能性相同。体重指数升高被证明是两种手术指征的乳房缩小术后发生并发症的统计学显著预测因素。两种手术的总体并发症发生率均较低，可接受。
