De Vita Roy, Buccheri Ernesto Maria, Pozzi Marcello, Zoccali Giovanni
Plastic Surgery Department, Regina Elena Cancer Institute of Rome, Rome, Italy.
J Exp Clin Cancer Res. 2014 Nov 25;33(1):78. doi: 10.1186/s13046-014-0078-5.
BACKGROUND: There has been a "rising tide" in mastectomy utilization that can be attributed to more skin-sparing mastectomies (SSMs) performed concurrently with immediate breast reconstruction. We report our experience of the first use of SERI Surgical Scaffold (SERI; Allergan, Inc.) in 21 cases of direct to implant (DTI) breast reconstruction after SSM. METHODS: Our retrospective experience, from April 2013 to May 2014, is based on 21 cases of direct to implant (DTI) breast reconstruction after SSM (9 monolateral 6 bilateral). All the patients were oncological with a preoperative cancer stage was into 0-2 stage. In order to assess the level of satisfaction with the aesthetical result, on 4-13 months post-operative patients were asked to complete a questionnaire that evaluated various parameters by means of a Visual Analogue Scale (V.A.S.). RESULTS: Over a 13-months period, a total of 15 patients underwent 21 immediate breast reconstructive procedures with Allergan Natrelle 410 style implants plus SERI after SSMs. Definitive histological examination give evidence of 5 patients intraductal carcinoma, 6 patients multifocal carcinoma and 4 patients carcinoma in situ. 6 bilateral cases of direct to implant (DTI) breast reconstruction after SSM had a monolateral oncological treatment and on the other side a prophylactic treatment. At the end of the short follow up (minimum 6 months) all the patient were cancer free with an excellent outcome. Complication rate presents just one implant exposure followed by a revised surgery. At V.A.S. the mean patient satisfaction was 5,77 (good), 4,09 (fair) for sensitivity of the nipple areola complex, 6,33 (good) assessment of implant position, 6,28 (good) self esteem, 5,2 (good) attraction ability, 4,99 (fair) intimate life, 6,81 (good) overall feelings about breast reconstruction, 6,71 (good) simmetry. CONCLUSIONS: The really encouraging results of our early experience will help surgeons introducing SERI into their practice to select appropriate patients for direct-to-implant single-stage immediate breast reconstruction. A larger study cohort and longer follow-up times are required to identify additional predictors and indications.
背景：乳房切除术的使用率呈“上升趋势”，这可归因于与即刻乳房重建同时进行的保乳手术（SSM）增多。我们报告了首次将SERI外科支架（SERI；艾尔建公司）用于21例保乳手术后直接植入式（DTI）乳房重建的经验。 方法：我们回顾了2013年4月至2014年5月期间21例保乳手术后直接植入式（DTI）乳房重建的病例（9例单侧，6例双侧）。所有患者均为肿瘤患者，术前癌症分期为0 - 2期。为了评估对美学效果的满意度，在术后4 - 13个月，要求患者完成一份问卷，通过视觉模拟量表（V.A.S.）评估各种参数。 结果：在13个月的时间里，共有15例患者在保乳手术后接受了21次即刻乳房重建手术，使用了艾尔建娜绮丽410型乳房植入物加SERI。最终组织学检查显示5例患者为导管内癌，6例患者为多灶性癌，4例患者为原位癌。6例保乳手术后双侧直接植入式（DTI）乳房重建病例中，一侧进行肿瘤治疗，另一侧进行预防性治疗。在短期随访（至少6个月）结束时，所有患者均无癌症，预后良好。并发症发生率仅为1例植入物外露，随后进行了修复手术。在视觉模拟量表中，患者对乳头乳晕复合体敏感度的平均满意度为5.77（良好），4.09（一般）；对植入物位置的评估为6.33（良好）；自尊为6.28（良好）；吸引力为5.2（良好）；亲密生活为4.99（一般）；对乳房重建的总体感受为6.81（良好）；对称性为6.71（良好）。 结论：我们早期经验中令人鼓舞的结果将有助于外科医生在实践中引入SERI，为直接植入式单阶段即刻乳房重建选择合适的患者。需要更大的研究队列和更长的随访时间来确定其他预测因素和适应症。
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