Department of General Surgery, Breast Unit, İstanbul University İstanbul School of Medicine, İstanbul, Turkey.
Department of Plastic Surgery, İstanbul University İstanbul School of Medicine, İstanbul, Turkey.
Balkan Med J. 2018 Jan 20;35(1):84-92. doi: 10.4274/balkanmedj.2017.0029. Epub 2017 Sep 29.
BACKGROUND: Implant-based breast reconstruction after mastectomy has recently been reported to be the preferred type of surgery among breast-specific surgeons and plastic surgeons. AIMS: To explore the significant clinicopathological factors associated with long-term outcome related to local recurrences of the nipple among patients who underwent immediate breast reconstruction with tissue expander or implant after mastectomy. STUDY DESIGN: Retrospective cohort. METHODS: From January 2007 to January 2013, 51 breast cancer patients who underwent immediate breast reconstruction with tissue expander or implant were retrospectively analysed. Patients' demographic data, clinicopathological characteristics, and clinical outcome by disease-free survival and disease-specific survival analyses were determined. RESULTS: The median follow-up was 64 (31-114) months. Of the 57 mastectomies, 41 were skin sparing mastectomy (72%) and 16 were nipple-areola sparing mastectomy (28%). Immediate breast reconstruction surgery included tissue expander (n=46, 81%) or implant (n=11, 19%) placement. The molecular subgroups of 47 invasive cancers were as follows: luminal A (n=23, 49%), luminal B (n=16, 34%), non-luminal HER2 (n=5, 10.6), triple negative breast cancer (n=3, 6.4%). The 5-years disease-specific survival, disease-free survival, and locoregional recurrence-free survival rates were 96.8%, 90%, and 97.6% respectively. Patients with luminal A cancer were found to have an improved 5-year disease-free survival time than other (luminal A; 100% vs. non-luminal A; 78%; p=0.028). Of the 14 nipple-areola sparing mastectomy, 13 had a close median tumour distance to nipple-areola complex (<20 mm) with a 5-year locoregional recurrence free survival of 100%. CONCLUSION: Immediate breast reconstruction with implant or tissue expander can be safely applied in patients undergoing skin sparing mastectomy or nipple-areola sparing mastectomy. Patients with luminal-A type show the most favourable outcome. During the 5-year follow-up period, patients even with close margins (<20 mm) to nipple-areola complex with nipple-areola sparing mastectomy have excellent locoregional and overall survival when treated by contemporary multidisciplinary oncological management.
背景：乳房切除术 后采用植入物的乳房重建术最近被报道为乳腺专科医生和整形外科医生首选的手术类型。
目的：探讨与接受乳房切除术 后即刻使用组织扩张器或植入物进行乳房重建的患者乳头局部复发相关的长期结果相关的显著临床病理因素。
研究设计：回顾性队列研究。
方法：2007 年 1 月至 2013 年 1 月，对 51 例接受即刻乳房重建的乳腺癌患者进行回顾性分析，使用组织扩张器或植入物。通过无病生存率和疾病特异性生存率分析确定患者的人口统计学数据、临床病理特征和临床结果。
结果：中位随访时间为 64（31-114）个月。57 例乳房切除术 中，41 例为保留皮肤的乳房切除术（72%），16 例为保留乳头乳晕的乳房切除术（28%）。即刻乳房重建手术包括组织扩张器（n=46，81%）或植入物（n=11，19%）的放置。47 例浸润性癌的分子亚组如下：Luminal A（n=23，49%）、Luminal B（n=16，34%）、非 Luminal HER2（n=5，10.6%）、三阴性乳腺癌（n=3，6.4%）。5 年疾病特异性生存率、无病生存率和局部区域无复发生存率分别为 96.8%、90%和 97.6%。Luminal A 型癌症患者的 5 年无病生存率高于其他患者（Luminal A：100% vs.非 Luminal A：78%；p=0.028）。在 14 例保留乳头乳晕的乳房切除术 中，有 13 例肿瘤与乳头乳晕复合体的中位距离较近（<20mm），5 年局部区域无复发生存率为 100%。
结论：即刻使用组织扩张器或植入物进行乳房重建可安全应用于接受保留皮肤或保留乳头乳晕的乳房切除术患者。Luminal-A 型患者的预后最佳。在 5 年随访期间，即使接受保留乳头乳晕的乳房切除术且肿瘤与乳头乳晕复合体的切缘较近（<20mm），通过当代多学科肿瘤管理治疗，患者也能获得极好的局部区域和总体生存率。
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