Department of Breast Radiology, Hospital Sirio-Libanês, São Paulo, Brazil.
Department of Radiation Oncology, Hospital Sirio-Libanês, São Paulo, Brazil.
Int J Radiat Oncol Biol Phys. 2018 Sep 1;102(1):82-91. doi: 10.1016/j.ijrobp.2018.05.023. Epub 2018 May 17.
Residual breast tissue (RBT) after mastectomy represents an unknown risk for local recurrence or development of a new cancer and affects decisions regarding adjuvant radiation therapy. This study used breast magnetic resonance imaging to evaluate the frequency of RBT and provide average thickness skin flap measurements in patients with total mastectomy, skin-sparing mastectomy, and nipple-sparing mastectomy (NSM) followed by breast reconstruction.
We carried out a retrospective analysis of 7432 consecutive postoperative breast magnetic resonance imaging examinations performed between August 2008 and July 2013, selecting 367 women (mean ± standard deviation age, 46.7 ± 8.7 years) who had undergone therapeutic or prophylactic mastectomy with reconstruction, for a total of 501 cases. The variables analyzed included fibroglandular tissue presence, skin flap thickness at 11 pre-established points, age, weight, height, body mass index, laterality, surgical indication, surgery type, reconstruction type, adjuvant therapy, and cancer treatment history. Statistical analyses were descriptive and comparative and included logistic regression models (P < .05).
At 9 of the 11 points of measure, the median thickness of the flap exceeded 5.5 mm. Excluding the areolar region, RBT was identified in 29.9% of the cases: 21.3% of the therapeutic mastectomy cases and 51% of the NSM cases. The variables independently associated with the presence of RBT were flap thickness (P < .001), patient height (P < .03), mastectomy indication (P < .001), mastectomy type (P < .012 for skin-sparing mastectomy and P < .001 for NSM and total mastectomy), and breast reconstruction with flap (P < .019).
All forms of mastectomy leave RBT. Our study has demonstrated that the RBT amount can be variable and quite prevalent. Because of the low quality of the evidence to ensure the oncological safety of sparing mastectomies, we suggest that knowledge of the extent of the remaining breast tissue is important for guiding additional surveillance and therapeutic interventions, including radiation therapy.
乳房切除术后残留的乳腺组织（RBT）代表局部复发或新发癌症的未知风险，并影响辅助放疗的决策。本研究使用乳腺磁共振成像评估全乳切除术、保留皮肤的乳房切除术和保留乳头的乳房切除术（NSM）后乳房重建患者的 RBT 发生率，并提供平均皮瓣厚度测量值。
我们对 2008 年 8 月至 2013 年 7 月期间进行的 7432 例连续术后乳腺磁共振成像检查进行了回顾性分析，选择了 367 名（平均±标准差年龄，46.7±8.7 岁）接受过保乳或预防性乳房切除术和重建的女性，共 501 例。分析的变量包括纤维腺体组织存在、11 个预先设定点的皮瓣厚度、年龄、体重、身高、体重指数、侧别、手术适应证、手术类型、重建类型、辅助治疗和癌症治疗史。统计分析为描述性和比较性，包括逻辑回归模型（P<.05）。
在 11 个测量点中的 9 个点，皮瓣的中位数厚度超过 5.5 毫米。排除乳晕区域后，29.9%的病例存在 RBT：21.3%的保乳手术病例和 51%的 NSM 病例。与 RBT 存在相关的独立变量包括皮瓣厚度（P<.001）、患者身高（P<.03）、乳房切除术适应证（P<.001）、乳房切除术类型（P<.012 为保留皮肤的乳房切除术，P<.001 为 NSM 和全乳切除术）和带皮瓣的乳房重建（P<.019）。
所有形式的乳房切除术都会留下 RBT。我们的研究表明，RBT 的数量可能是可变的，而且相当普遍。由于缺乏确保保乳术肿瘤学安全性的证据质量，我们建议了解残留乳腺组织的程度对于指导额外的监测和治疗干预措施很重要，包括放疗。
