Ribuffo D, Monfrecola A, Guerra M, Di Benedetto G M, Grassetti L, Spaziani E, Vitagliano T, Greco M
Unit of Plastic and Reconstructive Surgery, Department of Surgery, "Sapienza" University, Rome, Italy.
Eur Rev Med Pharmacol Sci. 2015 Jun;19(12):2202-7.
Post-mastectomy radiotherapy (PMRT) is well known in the plastic surgery community for having a negative impact on expander-implant based immediate breast reconstruction (IBBR), although recently some technical improvements allow better results. Very recent papers would suggest that there is no difference in postoperative complications in patients receiving post-mastectomy radiotherapy using modern techniques. However, study results are often biased by small groups of patients and by heterogeneity of radiotherapy timing, different surgical techniques and measured outcomes.
We have conducted a MEDLINE search to summarize the latest data (2012-2014) on the topic. Search was conducted using the following parameters: breast reconstruction AND implant AND expander AND post-mastectomy radiotherapy.
The MEDLINE search showed 53 reports, demonstrating a great interest on this topic; among these 37 dealed specifically with post-mastectomy radiotherapy after breast reconstruction. In particular, 15 were amenable to plastic surgeons, 6 to breast surgeons, 9 to radiotherapists and 7 to oncologists. Papers amenable to plastic surgeons highlighted the highest rate of undesired results, although with recent advances such as delayed-immediate reconstruction or protective lipofilling.
PMRT remains an undesired event when pursuing an implant-based breast reconstruction, although it does not represent an absolute contraindication. The higher rate of complications reported by plastic surgeons and not by other specialists can be explained with the greater attention to aesthetic details, such as capsular contractures, that our community has. Technical strategies to prevent complications described in this community now allow better results, should be well known and improved if possible in the future.
在整形外科领域，乳房切除术后放疗（PMRT）对基于扩张器-植入物的即刻乳房重建（IBBR）有负面影响是众所周知的，尽管最近一些技术改进带来了更好的效果。最近的论文表明，采用现代技术进行乳房切除术后放疗的患者术后并发症并无差异。然而，研究结果往往因患者群体规模小、放疗时间的异质性、不同的手术技术和测量结果而存在偏差。
我们进行了一项MEDLINE检索，以总结该主题的最新数据（2012 - 2014年）。检索使用了以下参数：乳房重建、植入物、扩张器、乳房切除术后放疗。
MEDLINE检索显示有53篇报告，表明对该主题有极大兴趣；其中37篇专门涉及乳房重建后的乳房切除术后放疗。具体而言，15篇适合整形外科医生，6篇适合乳腺外科医生，9篇适合放疗科医生，7篇适合肿瘤内科医生。适合整形外科医生的论文强调了不良结果的发生率最高，尽管有延迟即刻重建或保护性脂肪填充等最新进展。
在进行基于植入物的乳房重建时，PMRT仍然是一个不良事件，尽管它并不代表绝对禁忌证。整形外科医生报告的并发症发生率高于其他专科医生，这可以用我们这个领域对诸如包膜挛缩等美学细节的更多关注来解释。本领域描述的预防并发症的技术策略现在能带来更好的效果，应该广为人知，并在未来尽可能加以改进。
