From the Division of Surgery, Departments of Plastic Surgery and Breast Surgical Oncology, and the Department of Radiation Oncology, Division of Radiation Oncology, University of Texas M. D. Anderson Cancer Center.
Plast Reconstr Surg. 2020 May;145(5):1134-1142. doi: 10.1097/PRS.0000000000006722.
Oncoplastic breast-conserving surgery expands the indications for breast conservation. When performed using modified mastopexy/breast reduction techniques, the optimal timing of the contralateral symmetrizing mastopexy/breast reduction remains unclear. This study examined the effect of the timing of symmetrizing mastopexy/breast reduction on oncoplastic breast-conserving surgery outcomes.
A retrospective study was conducted of all patients who underwent oncoplastic breast-conserving surgery using mastopexy/breast reduction techniques at a single center from 2010 to 2016. Patients who received synchronous (immediate) contralateral breast symmetrizing mastopexy were compared with those who underwent a delayed symmetrizing mastopexy procedure. Demographic, treatment, and outcome data were collected. Descriptive statistics were used and multivariate analysis was performed to evaluate the various relationships.
There were 429 patients (713 breasts) included in the study; of these, 284 patients (568 breasts) underwent oncoplastic breast-conserving surgery involving mastopexy/breast reduction techniques and immediate symmetrizing mastopexy, and 145 patients underwent delayed contralateral symmetrizing mastopexy. The overall complication rate was similar between the immediate and delayed groups (25.4 percent versus 26.9 percent, respectively; p = 0.82), as was the major complication rate (10.6 percent versus 6.2 percent; p = 0.16). Complications resulted in a delay in adjuvant therapy in 18 patients (4.2 percent); in two patients (0.7 percent), this delay resulted from a complication in the contralateral symmetrizing mastopexy breast. Immediate contralateral symmetrizing mastopexy was not associated with increased risk of complications per breast (p = 0.82) or delay to adjuvant therapy (p = 0.6).
Contralateral mastopexy/breast reduction for symmetry can be performed at the time of oncoplastic breast-conserving surgery in carefully selected patients without significantly increasing the risk of complications or delay to adjuvant radiation therapy.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
肿瘤整形保乳手术扩大了保乳的适应证。当使用改良的乳房悬吊/乳房缩小技术进行手术时，对侧对称化乳房悬吊/乳房缩小的最佳时机仍不清楚。本研究探讨了对侧对称化乳房悬吊/乳房缩小的时机对肿瘤整形保乳手术结果的影响。
对 2010 年至 2016 年在单中心行肿瘤整形保乳手术中使用乳房悬吊/乳房缩小技术的所有患者进行回顾性研究。比较同期（即刻）行对侧乳房对称化乳房悬吊术的患者与行延迟性对称化乳房悬吊术的患者。收集患者的人口统计学、治疗和结局数据。采用描述性统计分析，并进行多变量分析以评估各种关系。
共纳入 429 例患者（713 侧乳房）；其中，284 例患者（568 侧乳房）接受了涉及乳房悬吊/乳房缩小技术的肿瘤整形保乳手术和即刻对侧乳房对称化乳房悬吊术，145 例患者接受了延迟性对侧乳房对称化乳房悬吊术。即刻组和延迟组的总体并发症发生率相似（分别为 25.4%和 26.9%，p=0.82），主要并发症发生率也相似（分别为 10.6%和 6.2%，p=0.16）。18 例患者（4.2%）的并发症导致辅助治疗延迟；在 2 例患者（0.7%）中，对侧对称化乳房悬吊术乳房的并发症导致辅助治疗延迟。每侧乳房即刻行对侧对称化乳房悬吊术与并发症风险增加无关（p=0.82）或辅助放疗延迟无关（p=0.6）。
在精心挑选的患者中，肿瘤整形保乳手术同期行对侧乳房悬吊/乳房缩小术不会显著增加并发症风险或延迟辅助放疗。
临床问题/证据水平：治疗性，III 级。
