Elston Joshua B, Prabhakaran Sangeetha, Lleshi Amina, Castillo Brianna, Sun Weihong, Kumar Ambuj, Ma Zhenjun, Smith Paul D, Dayicioglu Deniz
From the *Division of Plastic Surgery Residency Program, USF Health, University of South Florida; and †Division of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
Ann Plast Surg. 2017 Jun;78(6S Suppl 5):S269-S274. doi: 10.1097/SAP.0000000000001039.
Patients with a history of prior breast augmentation and newly diagnosed breast cancer represent a rapidly expanding and unique subset of patients. Prior studies have described changes in breast parenchyma and characteristic body habitus of previously augmented patients, as well as increased rates of capsular contracture associated with breast conservation therapy. In our current study, we aimed to study the risk factors contributing to morbidity and whether recurrence rates are higher in patients with prior breast augmentation undergoing lumpectomy or mastectomy for breast cancer and identify differences in complications between these 2 groups.
Retrospective analysis approved by institutional review board was performed on patients with prior breast augmentation undergoing lumpectomy (N = 52) and mastectomy (N = 64) for breast cancer.
Patients with prior breast augmentation undergoing mastectomy had a higher rate of complications compared with those undergoing lumpectomy (20.3% vs 5.9% respectively, P = 0.031), after adjusting for patient-specific factors including body mass index [odds ratio (OR), 0.242; 95% confidence interval (CI), 0.063-0.922; P = 0.0376], tumor stage (OR, 0.257; 95% CI, 0.064-1.036; P = 0.0562), smoking status (OR, 0.244; 95% CI, 0.065-0.918; P = 0.0370), and chemotherapy (OR, 0.242; 95% CI, 0.064-0.914; P = 0.0364). Four patients (7.7%) developed late complications in the lumpectomy group with 2 developing capsular contractures, 1 had fat necrosis and 1 needed complex reconstruction because of flattening of the nipple-areolar complex. There was no difference in recurrence or tumor margins between lumpectomy and mastectomy groups.
Patients with prior breast augmentation undergoing mastectomy have higher complication rates compared with lumpectomy even after adjusting for tumor stage. There appears to be no increased oncologic risk associated with either procedure given our current follow-up. Understanding these operative risks may help in patients' decision-making process with regards to type of oncologic surgery.
有过隆胸手术史且新诊断为乳腺癌的患者是一个快速增长的独特患者群体。先前的研究描述了隆胸患者乳房实质的变化、特征性体型，以及与保乳治疗相关的包膜挛缩发生率增加。在我们目前的研究中，我们旨在研究导致发病的危险因素，以及接受乳腺癌保乳手术或乳房切除术的隆胸患者的复发率是否更高，并确定这两组患者并发症的差异。
对接受乳腺癌保乳手术（N = 52）和乳房切除术（N = 64）的隆胸患者进行了经机构审查委员会批准的回顾性分析。
在调整了包括体重指数[比值比（OR），0.242；95%置信区间（CI），0.063 - 0.922；P = 0.0376]、肿瘤分期（OR，0.257；95%CI，0.064 - 1.036；P = 0.0562）、吸烟状况（OR，0.244；95%CI，0.065 - 0.918；P = 0.0370）和化疗（OR，0.242；95%CI，0.064 - 0.914；P = 0.0364）等患者特异性因素后，接受乳房切除术的隆胸患者的并发症发生率高于接受保乳手术的患者（分别为20.3%和5.9%，P = 0.031）。保乳手术组有4名患者（7.7%）出现晚期并发症，其中2例发生包膜挛缩，1例发生脂肪坏死，1例因乳头乳晕复合体扁平需要进行复杂重建。保乳手术组和乳房切除术组在复发或肿瘤切缘方面没有差异。
即使在调整肿瘤分期后，接受乳房切除术的隆胸患者的并发症发生率仍高于保乳手术患者。根据我们目前的随访情况，这两种手术似乎都没有增加肿瘤学风险。了解这些手术风险可能有助于患者在肿瘤手术类型的决策过程中做出选择。
