Potter S, Trickey A, Rattay T, O'Connell R L, Dave R, Baker E, Whisker L, Skillman J, Gardiner M D, Macmillan R D, Holcombe C
Population Health Sciences, Bristol Medical School, Bristol, UK.
Bristol Breast Care Centre, North Bristol NHS Trust, Bristol, UK.
Br J Surg. 2020 Jun;107(7):832-844. doi: 10.1002/bjs.11468. Epub 2020 Feb 19.
Therapeutic mammaplasty (TM) may be an alternative to mastectomy, but few well designed studies have evaluated the success of this approach or compared the short-term outcomes of TM with mastectomy with or without immediate breast reconstruction (IBR). Data from the national iBRA-2 and TeaM studies were combined to compare the safety and short-term outcomes of TM and mastectomy with or without IBR.
The subgroup of patients in the TeaM study who underwent TM to avoid mastectomy were identified, and data on demographics, complications, oncology and adjuvant treatment were compared with those of patients undergoing mastectomy with or without IBR in the iBRA-2 study. The primary outcome was the percentage of successful breast-conserving procedures in the TM group. Secondary outcomes included postoperative complications and time to adjuvant therapy.
A total of 2916 patients (TM 376; mastectomy 1532; mastectomy and IBR 1008) were included in the analysis. Patients undergoing TM were more likely to be obese and to have undergone bilateral surgery than those having IBR. However, patients undergoing mastectomy with or without IBR were more likely to experience complications than the TM group (TM: 79, 21·0 per cent; mastectomy: 570, 37·2 per cent; mastectomy and IBR: 359, 35·6 per cent; P < 0·001). Breast conservation was possible in 87·0 per cent of patients who had TM, and TM did not delay adjuvant treatment.
TM may allow high-risk patients who would not be candidates for IBR to avoid mastectomy safely. Further work is needed to explore the comparative patient-reported and cosmetic outcomes of the different approaches, and to establish long-term oncological safety.
治疗性乳房整形术（TM）可能是乳房切除术的一种替代方法，但很少有设计完善的研究评估这种方法的成功率，或比较TM与乳房切除术（无论是否进行即刻乳房重建[IBR]）的短期结果。将来自全国性iBRA-2和TeaM研究的数据合并，以比较TM与乳房切除术（无论是否进行IBR）的安全性和短期结果。
确定TeaM研究中为避免乳房切除术而接受TM的患者亚组，并将其人口统计学、并发症、肿瘤学和辅助治疗数据与iBRA-2研究中接受乳房切除术（无论是否进行IBR）的患者数据进行比较。主要结局是TM组保乳手术成功的百分比。次要结局包括术后并发症和辅助治疗时间。
分析共纳入2916例患者（TM 376例；乳房切除术1532例；乳房切除术加IBR 1008例）。与接受IBR的患者相比，接受TM的患者更可能肥胖且接受双侧手术。然而，无论是否进行IBR，接受乳房切除术的患者比TM组更易发生并发症（TM组：79例，21.0%；乳房切除术组：570例，37.2%；乳房切除术加IBR组：359例，35.6%；P＜0.001）。87.0%接受TM的患者能够保乳，且TM未延迟辅助治疗。
TM可能使不适合IBR的高危患者安全地避免乳房切除术。需要进一步开展工作，以探索不同方法在患者报告结局和美容效果方面的比较，并确定长期肿瘤学安全性。
