Mattingly Anne E, Ma Zhenjun, Smith Paul D, Kiluk John V, Khakpour Nazanin, Hoover Susan J, Laronga Christine, Lee M Catherine
From Breast Oncology, Biostatistics and Bioinformatics, and Plastic Surgery, H. Lee Moffitt Center and Cancer Institute, Tampa, Florida.
South Med J. 2017 Oct;110(10):660-666. doi: 10.14423/SMJ.0000000000000706.
Breast-conserving surgery with adjuvant radiation therapy (BCT) has been established as safe oncologically. Oncoplastic breast surgery uses both oncologic and plastic surgery techniques for breast conservation to improve cosmetic outcomes. We evaluated the risk factors associated with complications after oncoplastic breast reduction.
A single-institution, institutional review board-approved, retrospective review of electronic medical records of female patients with breast cancer who underwent oncoplastic breast reduction from 2008 to 2014. A review of electronic medical records collected relevant medical history, clinical and pathological information, and data on postoperative complications within 6 months stratified into major or minor complications. Categorical variables analyzed with the χ exact method; continuous variables were analyzed with the Wilcoxon rank sum test exact method.
We identified 59 patients; 4 required re-excision for positive margins, and 1 moved on to completion mastectomy. The overall complication rate was 33.9% (n = 20): 12 major (20.3%) and 8 minor (13.6%). Of the continuous variables (age, body mass index, and tissue removed), increased age was associated with minor complications ( = 0.02). Among the categorical variables (stratified body mass index, prior breast surgery, hypertension, diabetes mellitus, hyperlipidemia, vascular disease, pulmonary disease, and stratified weight of tissue removed), none were associated with overall or major complications. Pulmonary disease was associated with minor complications ( = 0.03). Bilateral versus unilateral oncoplastic breast reduction showed no statistically significant increase in complications.
The overall complication rate after oncoplastic breast reduction was markedly higher than that in nationally published data for breast-conserving surgery. The complication rate resembled more closely the complication rate after bilateral mastectomy with immediate reconstruction. No risk factors were associated with major or overall complications. Age and pulmonary disease were associated with minor complications. Patients should be selected and counseled appropriately when considering oncoplastic breast reduction.
保乳手术联合辅助放疗（BCT）在肿瘤学上已被确认为安全的手术方式。肿瘤整形乳房手术采用肿瘤学和整形外科学技术来进行乳房保留，以改善美容效果。我们评估了肿瘤整形乳房缩小术后并发症的相关危险因素。
对一家机构在2008年至2014年期间接受肿瘤整形乳房缩小术的女性乳腺癌患者的电子病历进行单机构、经机构审查委员会批准的回顾性研究。对电子病历的回顾收集了相关病史、临床和病理信息，以及6个月内术后并发症的数据，并分为主要或次要并发症。分类变量采用精确卡方检验分析；连续变量采用Wilcoxon秩和检验精确法分析。
我们确定了59例患者；4例因切缘阳性需要再次切除，1例继续进行全乳切除术。总体并发症发生率为33.9%（n = 20）：12例主要并发症（20.3%）和8例次要并发症（13.6%）。在连续变量（年龄、体重指数和切除组织量）中，年龄增加与次要并发症相关（P = 0.02）。在分类变量（分层体重指数、既往乳房手术史、高血压、糖尿病、高脂血症、血管疾病、肺部疾病和分层切除组织重量）中，没有一项与总体或主要并发症相关。肺部疾病与次要并发症相关（P = 0.03）。双侧与单侧肿瘤整形乳房缩小术在并发症方面没有统计学上的显著增加。
肿瘤整形乳房缩小术后的总体并发症发生率明显高于全国发表的保乳手术数据。该并发症发生率更接近于双侧乳房切除术后即刻重建的并发症发生率。没有危险因素与主要或总体并发症相关。年龄和肺部疾病与次要并发症相关。在考虑肿瘤整形乳房缩小术时，应适当选择患者并给予咨询。
