Department of Medicine and Surgery, Plastic Surgery Division, University of Parma, Parma; Cutaneous, Mini-invasive, Regenerative and Plastic Surgery Unit, Parma University Hospital, Parma, Italy.
Eur Rev Med Pharmacol Sci. 2017 Jun;21(11):2572-2585.
Breast cancer is the most common female cancer in Western populations, affecting 12.5% of women, with 1.38 million patients per year. Breast-conserving surgery followed by postoperative radiotherapy replaced the radical and modified-radical procedures of Halsted and Patey as the standard of care for early-stage breast cancer once the overall and disease-free survival rates of breast-conserving surgery were demonstrated to be equivalent to those of mastectomy. However, excision of >20% of breast tissue, low or centrally located cancer, and large-sized breasts with various grades of breast ptosis, result a in unacceptable cosmetic outcomes. Oncoplastic breast surgery evolved from the breast-conserving surgery by broadening its general indication to achieve wider excision margins without compromising on the cosmetic outcomes. Thus, oncoplastic breast surgery can be defined as a tumor-specific immediate breast reconstruction method that applies aesthetically derived breast reduction techniques to the field of breast cancer surgery and allows for higher volume excision with no aesthetic compromise. However, contralateral breast symmetrization should be regarded as an intrinsic component of the oncoplastic surgery. The main procedures involved are volume-displacement or volume-replacement techniques, which depend on breast size and cancer size/location. Volume-displacement or reshaping procedures apply the plastic surgery principles to transpose a dermo-glandular flap of breast tissue into the defect site, while volume-replacement techniques use autologous tissues to replace the volume loss that follows tumor resection. Furthermore, these procedures are more complex and time-consuming than those involved in breast-conserving surgery. Based on current literature, the authors analyze the different techniques and indications of the oncoplastic breast surgery, determining its complication rate, in order to help both surgeons and their patients in the decision-making stage of breast reconstruction.
乳腺癌是西方人群中最常见的女性癌症，影响 12.5%的女性，每年有 138 万患者。保乳手术后行术后放疗取代了 Halsted 和 Patey 的根治性和改良根治性手术，成为早期乳腺癌的标准治疗方法，因为保乳手术的总生存率和无病生存率已被证明与乳房切除术相当。然而，对于切除>20%的乳腺组织、肿瘤位置较低或中央、以及伴有各种程度乳房下垂的大乳房，会导致不可接受的美容效果。肿瘤整形乳房手术通过拓宽其一般适应证从保乳手术演变而来，在不影响美容效果的情况下实现更广泛的切除边缘。因此，肿瘤整形乳房手术可以定义为一种针对肿瘤的即刻乳房重建方法，它将美学衍生的乳房缩小技术应用于乳腺癌手术领域，并允许在不影响美容效果的情况下进行更高体积的切除。然而，对侧乳房对称化应被视为肿瘤整形手术的固有组成部分。主要涉及的手术程序是体积置换或体积替换技术，这取决于乳房大小和肿瘤大小/位置。体积置换或重塑程序应用整形手术原则将乳腺组织的真皮-腺体皮瓣转移到缺陷部位，而体积替换技术则使用自体组织来替代肿瘤切除后丢失的体积。此外，这些手术比保乳手术更复杂和耗时。基于目前的文献，作者分析了肿瘤整形乳房手术的不同技术和适应证，确定了其并发症发生率，以帮助外科医生及其患者在乳房重建的决策阶段做出决策。
