Prabhakaran Sangeetha, Elston Joshua B, Lleshi Amina, Kumar Ambuj, Sun Weihong, Khakpour Nazanin, Dayicioglu Deniz
From the *H. Lee Moffitt Cancer Center and Research Institute; and †Division of Plastic Surgery, Department of Surgery, Morsani College of Medicine, University of South Florida, Tampa, FL.
Ann Plast Surg. 2017 Jun;78(6S Suppl 5):S289-S291. doi: 10.1097/SAP.0000000000001040.
Increasing number of patients with preexisting breast implants desire breast conservation therapy for breast cancer. There is paucity of comparative data on tumor margins and re-excisions in these patients. High re-excision rates up to 25% have been reported in breast conservation therapy patients; efforts to obtain cosmesis and avoid implant rupture might increase this further. We analyzed tumor margins, re-excision rates, and recurrence in previously augmented versus non-augmented patients undergoing lumpectomy for breast cancer. We preserved preexisting implants if feasible with oncologic clearance and cosmesis.
Institutional review board-approved retrospective analysis was performed on patients undergoing lumpectomy with history of prior breast augmentation (N = 52) and consecutively selected non-augmented patients (N = 51). Based on tumor distance to inked margin, we grouped margins as negative (≥2 mm), close (<2 mm), and positive. Patients were followed up clinically and with imaging in the outpatient clinic, and recurrences were documented.
Patients in the non-augmented group were significantly more likely to have larger tumors (T2 and above; P = 0.05) compared with the augmented group. Although more patients in the augmented group had positive margins, this was not statistically significant (6 vs 3, P = 0.86). No difference was noted between re-excision rates among the augmented versus non-augmented groups (21.1% vs 19.6%, respectively; odds ratio, 0.91; 95% confidence interval, 0.35-2.37; P = 0.85); these remained unchanged even when adjusting for tumor stage (P = .75) and margins (P = 0.73). Although more patients in the augmented group recurred (4 vs 0), this was not statistically significant (P = 0.1).
Our results indicate that, from the oncological standpoint, patients with prior augmentation can undergo lumpectomy with equivalent tumor margins and re-excision rates. To the best of our knowledge, this is the first reported comparative study between these 2 groups.
越来越多植入过乳房假体的患者希望接受乳腺癌保乳治疗。关于这些患者的肿瘤切缘和再次切除的比较数据较少。据报道，保乳治疗患者的再次切除率高达25%；为了获得美观效果并避免植入物破裂而做出的努力可能会进一步提高这一比例。我们分析了接受乳腺癌肿块切除术的既往隆胸患者与未隆胸患者的肿瘤切缘、再次切除率和复发情况。如果可行，我们在保证肿瘤切除彻底和美观的前提下保留原有的植入物。
对接受过乳房增大术史的肿块切除术患者（N = 52）和连续入选的未隆胸患者（N = 51）进行了机构审查委员会批准的回顾性分析。根据肿瘤与标记切缘的距离，我们将切缘分为阴性（≥2 mm）、切缘接近（<2 mm）和阳性。对患者进行临床随访并在门诊进行影像学检查，记录复发情况。
与隆胸组相比，未隆胸组患者的肿瘤明显更大（T2及以上；P = 0.05）。虽然隆胸组中切缘阳性的患者更多，但差异无统计学意义（6例对3例，P = 0.86）。隆胸组与未隆胸组的再次切除率无差异（分别为21.1%对19.6%；优势比，0.91；95%置信区间，0.35 - 2.37；P = 0.85）；即使在调整肿瘤分期（P = 0.75）和切缘（P = 0.73）后，这些结果仍保持不变。虽然隆胸组复发的患者更多（4例对0例），但差异无统计学意义（P = 0.1）。
我们的结果表明，从肿瘤学角度来看，既往隆胸患者可以接受肿块切除术，其肿瘤切缘和再次切除率相当。据我们所知，这是首次报道的这两组之间的比较研究。
