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基于几何补偿的肿瘤整形保乳术:一项多中心回顾性队列研究中的技术演变、结果和随访。

Oncoplastic mammaplasty with geometric compensation: Evolution of the technique, outcomes and follow-up in a multicentre retrospective cohort.

机构信息

Breast Program, Department of Gynaecology and Obstetrics, Federal University of Goiás, Goiânia, Goiás, Brazil.

Gynaecology and Breast Unit, Araújo Jorge Hospital, ACCG, Goiânia, Goiás, Brazil.

出版信息

J Surg Oncol. 2020 May;121(6):967-974. doi: 10.1002/jso.25860. Epub 2020 Feb 4.

Abstract

BACKGROUND AND OBJECTIVES

To report on the outcomes and evolution of an oncoplastic mammaplasty referred to as geometric compensation mammaplasty.

METHODS

Seventy-three patients with malignant tumours were operated on and followed up in five centres in two countries. Preoperative markings were performed using a Wise pattern. The resection of affected skin was geometrically compensated using another area of preserved skin.

RESULTS

Mean pathological tumour size was 30.42 ± 21.98 mm. Twenty tumours (30.77%) were locally advanced and 15 (20.55%) were multicentric. Twenty-two patients (34.38%) were submitted to neoadjuvant chemotherapy. Cosmetic results were considered good or excellent in 59 cases (80.82%). Margins were positive in two cases (2.74%). Complications were partial wound dehiscence (n = 11; 15.07%), fat necrosis (n = 9; 12.33%), skin necrosis (n = 5; 6.85%), seromas (n = 5; 6.85%), enlarged scars (n = 7; 9.59%) and infection (n = 2; 2.74%). There were three cases of local recurrence (4.29%), two of bone metastasis (2.86%) and three of metachronous contralateral breast cancer (4.35%). No deaths were recorded within a mean follow-up of 35.33 ± 28.21 months.

CONCLUSIONS

The technique allowed breast conservation in situations requiring a large resection of skin in difficult positions, with a high rate of free margins, correction of ptosis, satisfactory symmetry and few complications.

摘要

背景与目的

报告一种名为几何补偿乳房成形术的保乳整形术的结果和演变。

方法

在两个国家的五个中心对 73 名患有恶性肿瘤的患者进行了手术和随访。使用 Wise 模式进行术前标记。使用另一个保留皮肤区域对受影响的皮肤进行几何补偿切除。

结果

平均病理肿瘤大小为 30.42±21.98mm。20 个肿瘤(30.77%)为局部晚期,15 个(20.55%)为多中心。22 例(34.38%)患者接受新辅助化疗。59 例(80.82%)美容效果良好或优秀。2 例(2.74%)边缘阳性。并发症包括部分伤口裂开(11 例,15.07%)、脂肪坏死(9 例,12.33%)、皮肤坏死(5 例,6.85%)、血清肿(5 例,6.85%)、疤痕扩大(7 例,9.59%)和感染(2 例,2.74%)。局部复发 3 例(4.29%),骨转移 2 例(2.86%),对侧乳腺癌同期转移 3 例(4.35%)。在平均 35.33±28.21 个月的随访中无死亡记录。

结论

该技术允许在需要切除困难位置大面积皮肤的情况下进行保乳,切缘阳性率高,可纠正乳房下垂,获得满意的对称性,并发症少。

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