Ho Quoc C, Faure C, Carrabin N, Istasse F, Rivoire M, Delay E
Cabinet privé : clinique du Val d'Ouest, 39, chemin de la Vernique, 69130 Ecully, France; Centre Léon Bérard, 28, rue Laennec, 69008 Lyon, France.
Centre Léon Bérard, 28, rue Laennec, 69008 Lyon, France.
J Gynecol Obstet Biol Reprod (Paris). 2015 Jun;44(6):510-5. doi: 10.1016/j.jgyn.2014.07.002. Epub 2014 Sep 4.
Breast conservative surgeries, associated with radiotherapy within the framework of conservatives treatments for breast malignant tumors, can occur deformation of the breast in 10 to 15% of cases. The deformity can be more or less important according to the size of the initial lesion and the glandular reshaping reconstruction. Our experience in oncologic and reconstructive surgery of the breast reflects us about difficult cases of breast conservative surgeries in a glandular reshaping to obtain the best aesthetic result. In this approach, the posterior glandular flap of the breast was used in specific indications. The study aims to estimate the efficiency and the tolerance of the posterior glandular flap in difficult cases of breast oncoplastic surgeries.
We realized a consecutive serie of 24 breast oncoplastic surgeries. We noticed 15 breast conservative surgeries of superior quadrants. The posterior glandular flap was realized in 15 cases. We used the posterior part of the breast, vascularized by musculo-cutaneous intercostal arteries to give the volume lacking in the breast. We estimated efficiency and tolerance of the posterior glandular flap than one-year operating comment, as well as the oncologic follow-up long-term.
In this serie of 15 cases, we did not note acute complications like infection, hematoma or cutaneous necrosis. We listed 13 cases of malignant tumors with indication of radiotherapy, and 2 cases of benign tumors. In one year, we found two patients presenting a cyst of cytosteatonecrosis (1cm and 3cm) in the site of surgery, compared to posterior flap. The glandular total average excision was 333g (30-1200). An oncologic surgical resumption was necessary in 2 cases (a case of preventive mastectomy for BRCA1, and a case of insufficient margins). We realized 12 cases of controlateral surgery at the same time for symmetry. The aesthetic result was judged at one year post-operatory: good or very good in 74% of the cases, correct in 20% of the cases, and insufficient in 6% of the cases. The oncologic follow-up did not find locoregional recurrence.
The posterior glandular flap is an interesting contribution in oncoplastic surgery of superior quadrants of the breast to replace harmoniously the missing volume. This flap, reliable and reproductible, offers an alternative to bring of the custom-made volume without residual deformation of the breast. The aesthetic results allowed, in spite of the radiotherapy, to decrease the aftereffects of breast conservative surgery treatments, and this interesting approach deserves a wider distribution.
在乳腺恶性肿瘤的保守治疗框架内，保乳手术联合放疗，在10%至15%的病例中可能会出现乳房变形。根据初始病变的大小和腺体重塑重建情况，畸形的程度可能或多或少有所不同。我们在乳腺肿瘤和重建手术方面的经验让我们思考了在腺体重塑的保乳手术困难病例中如何获得最佳美学效果。在这种方法中，乳房后腺体瓣被用于特定适应症。本研究旨在评估后腺体瓣在乳腺肿瘤整形手术困难病例中的有效性和耐受性。
我们连续进行了24例乳腺肿瘤整形手术。我们注意到15例上象限的保乳手术。15例实施了后腺体瓣手术。我们利用由肋间肌皮动脉供血的乳房后部来补充乳房缺失的体积。我们通过一年的手术评估以及长期的肿瘤学随访来评估后腺体瓣的有效性和耐受性。
在这15例病例中，我们未注意到感染、血肿或皮肤坏死等急性并发症。我们列出了13例有放疗指征的恶性肿瘤病例和2例良性肿瘤病例。在一年时间里，我们发现有两名患者在手术部位出现了细胞脂肪坏死囊肿（分别为1厘米和3厘米），与后瓣相关。腺体的平均总切除量为333克（30 - 1200克）。有2例需要进行肿瘤外科再次手术（1例因BRCA1进行预防性乳房切除术，1例切缘不足）。我们同时进行了12例对侧手术以保持对称。术后一年对美学效果进行评估：74%的病例效果良好或非常好，20%的病例效果尚可，6%的病例效果欠佳。肿瘤学随访未发现局部区域复发。
后腺体瓣为乳腺上象限肿瘤整形手术提供了一个有趣的方法，能够和谐地替代缺失的体积。这种瓣可靠且可重复，提供了一种替代方案，可提供定制的体积而不会使乳房残留变形。尽管有放疗，美学效果仍能减少保乳手术治疗的后遗症，这种有趣的方法值得更广泛地推广。
