Terao Yasunobu, Taniguchi Koichiro, Fujii Miwako, Moriyama So
Department of Plastic and Reconstructive Surgery, Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, Japan.
Breast Cancer. 2017 Jul;24(4):505-510. doi: 10.1007/s12282-017-0760-5. Epub 2017 Feb 22.
Immediate breast reconstruction is an important tool for patients to accept and overcome their breast cancer, as well as for cosmetic reasons. However, its use in patients who require postmastectomy radiation therapy (PMRT) is not yet clear. The purpose of this study was to analyze the effects of PMRT and reconstruction on each other. The time of initiation of PMRT, the prognosis, and the cosmetic results were investigated in patients who underwent immediate reconstruction using autologous tissue. In the case of delayed reconstruction using autologous tissue after PMRT, radiation damage of the chest skin, design of the flap, and cosmetic results were investigated. In 38 patients who underwent immediate reconstruction and PMRT between 2006 and 2015, 20 patients received neoadjuvant chemotherapy, and their mean time before starting PMRT was 9.7 weeks after surgery (range 7-18 weeks). Three patients underwent delayed PMRT (more than 12 weeks) due to partial flap necrosis and wound infection. Of 28 patients (2006-2010), 23 were disease free (stage I: 2/2, stage II: 15/16, stage III: 6/10), one patient (stage III) had distant metastases, and 4 patients died of primary disease (stage II: 1/16, stage III: 3/10). Unacceptable deformation of the reconstructed breast was observed in 4 patients who had partial fat necrosis of the grafted flap or skin necrosis of the mastectomy flap. In 20 patients who underwent delayed reconstruction between 2006 and 2015, 15 (75%) patients underwent replacement of irradiated chest skin with flap skin to reconstruct a soft and natural shape breast. The flap survival rate was 100%, and unacceptable deformation of the reconstructed breast was not seen. In the case of immediate reconstruction using autologous tissue, it is important to graft a flap with a good blood supply to avoid delaying PMRT and achieving a good cosmetic result, because flap necrosis or wound infection delays PMRT and causes scar contracture after PMRT. In the case of delayed reconstruction after PMRT, chest wall skin with radiation damage should be resected and replaced by flap skin.
即刻乳房重建对于患者接受并战胜乳腺癌以及出于美容目的而言都是一项重要手段。然而，其在需要乳房切除术后放疗（PMRT）的患者中的应用尚不明晰。本研究的目的是分析PMRT与重建彼此之间的影响。对采用自体组织进行即刻重建的患者的PMRT起始时间、预后及美容效果进行了研究。对于PMRT后采用自体组织进行延迟重建的情况，对胸部皮肤的放射性损伤、皮瓣设计及美容效果进行了研究。在2006年至2015年间接受即刻重建及PMRT的38例患者中，20例接受了新辅助化疗，其开始PMRT前的平均时间为术后9.7周（范围7 - 18周）。3例患者因部分皮瓣坏死及伤口感染接受了延迟PMRT（超过12周）。在28例患者（2006 - 2010年）中，23例无疾病（I期：2/2，II期：15/16，III期：6/10），1例患者（III期）有远处转移，4例患者死于原发性疾病（II期：1/16，III期：3/10）。在4例移植皮瓣出现部分脂肪坏死或乳房切除皮瓣皮肤坏死的患者中观察到重建乳房出现不可接受的变形。在2006年至2015年间接受延迟重建的20例患者中，15例（75%）患者采用皮瓣皮肤替换受照射的胸部皮肤以重建柔软自然形态的乳房。皮瓣存活率为100%，未见到重建乳房出现不可接受的变形。在采用自体组织进行即刻重建的情况下，移植血供良好的皮瓣很重要，以避免延迟PMRT并获得良好的美容效果，因为皮瓣坏死或伤口感染会延迟PMRT并导致PMRT后瘢痕挛缩。在PMRT后进行延迟重建的情况下，应切除受放射性损伤的胸壁皮肤并用皮瓣皮肤替换。
