Negenborn Vera L, Volders José H, Krekel Nicole M A, Haloua Max H, Bouman Mark-Bram, Buncamper Marlon E, Niessen Frank B, Winters Hay A H, Terwee Caroline B, Meijer Sybren, van den Tol M Petrousjka
Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands; EMGO+ Institute for Health and Care Research, VU University Medical Centre, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.
Department of Surgical Oncology, VU University Medical Centre, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
J Plast Reconstr Aesthet Surg. 2017 Oct;70(10):1336-1344. doi: 10.1016/j.bjps.2017.05.005. Epub 2017 May 18.
Optimisation of the cosmetic outcome after breast-conserving therapy (BCT) is important. We aimed to determine the cosmetic outcome following BCT and factors influencing this cosmesis and identify the most favourable options for delayed breast reconstruction.
Four reconstructive surgeons evaluated the cosmetic outcome of 109 patients after BCT. Additionally, the surgeons indicated which patients were amenable for delayed reconstruction and the preferred type of reconstruction. The inter- and intra-observer agreement of the surgeons was rated.
The mean overall cosmetic outcome was rated as fair (2.7/4.0, SD 0.9, 1.0-4.0). Risk factors for a poor cosmesis were larger breast size (OR 3.81, p = 0.040), larger tumour (OR 1.63, p = 0.028) and axillary lymph node dissection (ALND) (OR 3.09, p = 0.013). Reconstruction of the ipsilateral side was recommended in 55.6% and 94.5% and contralateral reconstruction in 16.7% and 73.3% of patients with good and poor cosmesis, respectively. Flap reconstruction and lipofilling were most commonly reported for the ipsilateral, and breast reduction for the contralateral breast, with reasonable improvement expected (2.2/4.0, SD 0.5, 1.08-3.3). The inter- (0.5-0.7) and intra-observer (0.63-0.79) agreement of the cosmesis was moderate to good, however, poor regarding the recommended reconstruction techniques (mainly < 0.50).
Cosmetic outcome after BCT is influenced by breast and tumour size and ALND. Although several reconstructive options are available, the optimal method for revision surgery has not yet been determined. Future studies are necessary to obtain evidence-based guidelines for reconstructive surgery after BCT.
保乳治疗（BCT）后优化美容效果很重要。我们旨在确定BCT后的美容效果以及影响该美容效果的因素，并确定延迟乳房重建的最有利方案。
四位重建外科医生评估了109例患者BCT后的美容效果。此外，外科医生指出哪些患者适合延迟重建以及首选的重建类型。对外科医生之间以及观察者内部的一致性进行了评分。
总体美容效果平均评分为一般（2.7/4.0，标准差0.9，范围1.0 - 4.0）。美容效果差的危险因素包括乳房尺寸较大（比值比3.81，p = 0.040）、肿瘤较大（比值比1.63，p = 0.028）和腋窝淋巴结清扫术（ALND）（比值比3.09，p = 0.013）。美容效果好和差的患者中，分别有55.6%和94.5%的患者建议同侧重建，16.7%和73.3%的患者建议对侧重建。同侧最常报告的是皮瓣重建和脂肪填充，对侧乳房最常报告的是乳房缩小术，预期有合理改善（2.2/4.0，标准差0.5，范围1.08 - 3.3）。美容效果的观察者间一致性（0.5 - 0.7）和观察者内部一致性（0.63 - 0.79）为中等至良好，但在推荐的重建技术方面较差（主要<0.50）。
BCT后的美容效果受乳房和肿瘤大小以及ALND影响。虽然有几种重建选择，但翻修手术的最佳方法尚未确定。未来有必要进行研究以获得BCT后重建手术的循证指南。
