Ishii Naohiro, Ando Jiro, Harao Michiko, Takemae Masaru, Kishi Kazuo
Department of Plastic and Reconstructive Surgery, Tochigi Cancer Center, Tochigi, Japan.
Department of Breast Surgery, Tochigi Cancer Center, Tochigi, Japan.
J Plast Reconstr Aesthet Surg. 2017 Oct;70(10):1363-1368. doi: 10.1016/j.bjps.2017.05.013. Epub 2017 May 19.
Adjuvant chemotherapy and anti-estrogenic therapy can result in decreased volume of the contralateral breast, following mastectomy for the treatment of breast cancer. However, no data on the effect of adjuvant therapy on contralateral breast volume have previously been reported. We aimed to evaluate the extent to which adjuvant therapy and differences in breast density contribute to decreased breast volume. We conducted a prospective cohort study, selecting 40 nonconsecutive patients who underwent immediate breast reconstruction with mastectomy and expander insertion followed by expander replacement. We measured the contralateral breast volume before each procedure. The extent of the change was analyzed with respect to adjuvant therapy and breast density measured by preoperative mammography. The greatest decrease in breast volume was 135.1 cm. The decrease in breast volume was significantly larger in the adjuvant therapy (+) group, particularly in patients with high breast density, than in the adjuvant therapy (-) group. Significant differences between the chemotherapy (+), tamoxifen (+) group and the chemotherapy (-), tamoxifen (+) group were not found. Breast density scores had a range of 2.0-3.3 (mean: 2.8). In breast reconstruction, particularly when performed in one stage, preoperative mammography findings are valuable to plastic surgeons, and possible decreases in the contralateral breast volume due to adjuvant therapy, particularly in patients with high breast density, should be considered carefully.
辅助化疗和抗雌激素治疗可导致乳腺癌患者在乳房切除术后对侧乳房体积减小。然而，此前尚无关于辅助治疗对侧乳房体积影响的数据报道。我们旨在评估辅助治疗和乳房密度差异对乳房体积减小的影响程度。我们进行了一项前瞻性队列研究，选取了40例非连续患者，这些患者接受了乳房切除并植入扩张器，随后进行扩张器置换的即刻乳房重建手术。我们在每次手术前测量对侧乳房体积。分析了辅助治疗和术前乳腺钼靶测量的乳房密度变化程度。乳房体积最大减小了135.1立方厘米。辅助治疗（+）组，尤其是乳房密度高的患者，乳房体积减小明显大于辅助治疗（-）组。化疗（+）、他莫昔芬（+）组与化疗（-）、他莫昔芬（+）组之间未发现显著差异。乳房密度评分范围为2.0 - 3.3（平均：2.8）。在乳房重建中，尤其是一期进行时，术前乳腺钼靶检查结果对整形外科医生很有价值，应仔细考虑辅助治疗导致对侧乳房体积可能减小的情况，尤其是乳房密度高的患者。
