Maruccia M, Mazzocchi M, Dessy L A, Onesti M G
Department of Surgery "P. Valdoni", Unit of Plastic and Reconstructive Surgery Sapienza University, Rome, Italy.
Eur Rev Med Pharmacol Sci. 2016 Dec;20(24):5058-5066.
The aim of this study was to review one-stage breast reconstruction techniques performed in elderly patients at our institution to identify the criteria of selection of each in terms of outcomes and quality of life.
Patients older than 65 years who underwent one-stage breast reconstruction between January 2004 and July 2014 at our hospital were included. Patients and procedure-related data were collected from the medical records. In particular, patient's age, comorbidities and related ASA physical status, type of one-stage breast reconstruction technique, and criteria of selection were analyzed. Outcomes and results were also evaluated in terms of quality of life using the EORTC QLQ-C30 and -BR23 questionnaires 1 year after surgery.
A total of 840 women underwent breast reconstruction, of whom 138 elderly women received one-stage breast reconstruction. There were 118 cases (85.5%) of monolateral reconstructions and 20 cases (14.5%) of bilateral reconstructions, resulting in 138 breast reconstructions. These were performed with permanent inflatable expanders in the sub-muscular position (Group A, n= 50), with acellular dermal matrix and partial sub-muscular anatomic implant (Group B, n= 50), and with Braxon® acellular dermal matrix and anatomic implant with muscle-sparing technique (Group C, n= 38). The EORTC questionnaires showed the best results in Group C regarding the quality of life.
The elderly population is rapidly increasing, and 50% of all breast cancers occur in women older than 65 years; among them, only 2% undergo breast reconstruction. A major aspect of breast cancer treatment and subsequent quality of life is the opportunity for a post-mastectomy reconstructive surgery. As survival rates are improving, a larger proportion of patients live with the long-term consequences of their treatment, and breast reconstruction ensures a better quality of life. To increase the reconstruction rates, surgery should be one-stage, less invasive as possible, allowing rapid recovery, especially in elderly women, in whom comorbidities are often present with a higher anaesthetic risk. Our study highlighted that non-skin sparing mastectomy (SSM) and delayed reconstructions should be addressed with Becker implants; immediate reconstructions after SSM should be followed by acellular dermal matrix (ADM)-assisted implant reconstruction, preferring the wrap technique offers a better quality of life in elderly patients.
本研究旨在回顾我院对老年患者实施的一期乳房重建技术，以根据手术效果和生活质量确定每种技术的选择标准。
纳入2004年1月至2014年7月在我院接受一期乳房重建的65岁以上患者。从病历中收集患者及与手术相关的数据。特别分析了患者的年龄、合并症及相关美国麻醉医师协会（ASA）身体状况、一期乳房重建技术类型和选择标准。术后1年还使用欧洲癌症研究与治疗组织（EORTC）QLQ-C30和-BR23问卷从生活质量方面评估手术效果和结果。
共有840名女性接受了乳房重建，其中138名老年女性接受了一期乳房重建。单侧重建118例（85.5%），双侧重建20例（14.5%），共进行了138次乳房重建。这些重建手术分别采用肌下永久充气扩张器（A组，n = 50）、脱细胞真皮基质和部分肌下解剖型植入物（B组，n = 50）以及Braxon®脱细胞真皮基质和保留肌肉技术的解剖型植入物（C组，n = 38）。EORTC问卷显示C组在生活质量方面结果最佳。
老年人口正在迅速增加，所有乳腺癌中有50%发生在65岁以上的女性中；其中只有2%接受乳房重建。乳腺癌治疗及后续生活质量的一个主要方面是乳房切除术后重建手术的机会。随着生存率的提高，越来越多的患者要承受治疗带来的长期后果，而乳房重建可确保更好的生活质量。为提高重建率，手术应采用一期、尽可能微创的方式，以实现快速康复，尤其是对于常伴有较高麻醉风险合并症的老年女性。我们的研究强调，非保乳乳房切除术（SSM）和延迟重建应采用贝克尔植入物；SSM后的即刻重建应采用脱细胞真皮基质（ADM）辅助植入物重建，采用包裹技术对老年患者的生活质量更佳。
