已有胸大肌下植入物的乳腺癌患者重建结果的比较：保留植入物的乳房切除术并延迟更换植入物与即刻组织扩张器重建。

Comparison of Reconstructive Outcomes in Breast Cancer Patients With Preexisting Subpectoral Implants: Implant-Sparing Mastectomy With Delayed Implant Exchange Versus Immediate Tissue Expander Reconstruction.

作者信息

Prabhakaran Sangeetha, Melody Megan, Trotta Rose, Lleshi Amina, Sun Weihong, Smith Paul D, Khakpour Nazanin, Dayicioglu Deniz

机构信息

From the *Department of Women's Oncology, H. Lee Moffitt Cancer Center and Research Institute; †University of South Florida Morsani College of Medicine; ‡H. Lee Moffitt Cancer Center and Research Institute; and §Division of Plastic Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL.

出版信息

Ann Plast Surg. 2016 Jun;76 Suppl 4:S332-S335. doi: 10.1097/SAP.0000000000000751.

DOI:10.1097/SAP.0000000000000751

PMID:27755066

Abstract

BACKGROUND

Women who have undergone prior augmentation mammoplasty represent a unique subset of breast cancer patients with several options available for breast reconstruction. We performed a single institution review of surgical outcomes of breast reconstruction performed in patients with breast cancer with prior history of subpectoral breast augmentation.

METHODS

Institutional review board-approved retrospective review was conducted among patients with previously mentioned criteria treated at our institution between 2000 and 2014. Reconstructions were grouped into 2 categories as follows: (1) removal of preexisting subpectoral implant during mastectomy with immediate tissue expander placement and (2) implant-sparing mastectomy followed by delayed exchange to a larger implant. We reviewed demographics, tumor features, and reconstruction outcomes of these groups.

RESULTS

Fifty-three patients had preexisting subpectoral implants. Of the 63 breast reconstructions performed, 18 (28.6%) had immediate tissue expander placed and 45 (71.4%) had implant-sparing mastectomy followed by delayed implant exchange. The groups were comparable based on age, body mass index, cancer type, tumor grade, TNM stage at presentation, and hormonal receptor status. No significant difference was noted between tumor margins or subsequent recurrence, mastectomy specimen weight, removed implant volume, volume of implant placed during reconstruction, or time from mastectomy to final implant placement. Rates of complications were significantly higher in the tissue expander group compared to the implant-sparing mastectomy group 7 (38.9%) versus 4 (8.9%) (P = 0.005).

CONCLUSIONS

Implant-sparing mastectomy with delayed implant exchange in patients with preexisting subpectoral implants is safe and has fewer complications compared to tissue expander placement. There was no difference noted in the final volume of implant placed, time interval for final implant placement, or tumor margins.

摘要

背景

曾接受过隆乳术的女性是乳腺癌患者中的一个特殊亚组，乳房重建有多种选择。我们对有胸肌下乳房增大术病史的乳腺癌患者进行乳房重建的手术结果进行了单机构回顾。

方法

对2000年至2014年在我们机构接受治疗且符合上述标准的患者进行机构审查委员会批准的回顾性研究。重建分为以下两类：（1）乳房切除术中取出原有的胸肌下植入物并立即放置组织扩张器；（2）保留植入物的乳房切除术，随后延迟更换为更大的植入物。我们回顾了这些组的人口统计学、肿瘤特征和重建结果。

结果

53例患者有原有的胸肌下植入物。在进行的63例乳房重建中，18例（28.6%）立即放置了组织扩张器，45例（71.4%）进行了保留植入物的乳房切除术，随后延迟更换植入物。两组在年龄、体重指数、癌症类型、肿瘤分级、就诊时的TNM分期和激素受体状态方面具有可比性。在肿瘤切缘或随后的复发、乳房切除标本重量、取出的植入物体积、重建期间放置的植入物体积或从乳房切除到最终植入的时间方面未发现显著差异。组织扩张器组的并发症发生率明显高于保留植入物乳房切除术组，分别为7例（38.9%）和4例（8.9%）（P = 0.005）。