Radu M, Bordea C, Noditi A, Blidaru A
"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
Institute of Oncology Bucharest "Prof. Dr. Al. Trestioreanu", Department of Surgical Oncology, Bucharest, Romania.
J Med Life. 2018 Apr-Jun;11(2):137-145.
The aim of this study is to identify the appropriate preoperative evaluation methods for the quality of the skin flaps and subcutaneous breast layer using different imaging techniques in correlation with the intraoperative findings and also their importance for the outcome in immediate implant-based breast reconstruction. Clinical evaluation, mammography, breast ultrasound and breast MRI were used for the assessment of the mastectomy skin flaps which enhanced the selection of the adequate surgical technique for breast reconstruction. The evaluation started with the skin flap measurement of 50 patients with breast cancer, who were candidates for modified radical mastectomy (MRM) in 2014, using the above-mentioned methods, without immediate breast reconstruction. Consequently, 46 nipple-sparing mastectomies (NSM) and 21 skin-sparing mastectomies (SSM) with immediate breast reconstruction with implants were performed between 2014 and 2017 after having such a preoperative subcutaneous tissue thickness evaluation. The intraoperative findings of the MRM group showed a 90% accuracy for the MRI preoperative evaluation, 87% for the ultrasound, 81% for the mammography and 71% for the pinch test. The preoperative measurements for the patients undergoing SSM or NSM were a criterion for choosing the surgical technique for breast reconstruction. The rate of postoperative complications was low. Preoperative clinical measurements, breast ultrasound, breast MRI and mammography can enhance the prediction of the skin flap thickness and thus lead to a low rate of complications and good aesthetic results in implant-based immediate breast reconstruction.
本研究的目的是使用不同的成像技术，结合术中发现，确定用于评估皮瓣和乳房皮下层质量的合适术前评估方法，以及它们在即刻乳房假体植入重建中对手术结果的重要性。临床评估、乳腺钼靶、乳腺超声和乳腺磁共振成像用于评估乳房切除皮瓣，这有助于选择合适的乳房重建手术技术。评估始于对2014年50例乳腺癌患者的皮瓣测量，这些患者均为改良根治性乳房切除术（MRM）的候选者，采用上述方法，未进行即刻乳房重建。因此，在进行了这样的术前皮下组织厚度评估后，于2014年至2017年间进行了46例保留乳头乳房切除术（NSM）和21例保留皮肤乳房切除术（SSM）并即刻植入乳房重建。MRM组的术中发现显示，MRI术前评估的准确率为90%，超声为87%，乳腺钼靶为81%，捏压试验为71%。接受SSM或NSM患者的术前测量是选择乳房重建手术技术的一个标准。术后并发症发生率较低。术前临床测量、乳腺超声、乳腺磁共振成像和乳腺钼靶可以提高对皮瓣厚度的预测，从而在即刻乳房假体植入重建中导致低并发症发生率和良好的美学效果。
