Oncologic and Oncoplastic Breast Surgery, The Paris Breast Centre- L'Institut du Sein Paris, 9 av. Mac Mahon, 75017, Paris, France.
Plastic and Reconstructive Surgery, Hôpital Tenon, AP-HP, 4 rue de la Chine, 75020, Paris, France.
Eur J Surg Oncol. 2020 Aug;46(8):1456-1462. doi: 10.1016/j.ejso.2020.05.008. Epub 2020 May 12.
Breast cancer in women with cosmetic breast implants is increasingly common. Over the past decade, there has been a push for mastectomy and reconstruction in these patients, based on a fear of poor aesthetic results from small breast volume, and radiation-induced capsular contracture. At the Paris Breast Centre, augmented women routinely undergo lumpectomy with whole-breast irradiation (BCT).
A consecutive cohort of 50 augmented women, who had attempted BCT for early breast cancer at our institution between 2003 and 2018, were retrospectively identified. Post-treatment complications, oncologic outcomes, capsular contracture rates, long-term cosmetic outcomes, and patient-reported outcomes were evaluated.
The median follow-up was 51 months. Margins were involved in 7 women (14%); 4 of whom underwent successful re-excision, and 3 had a mastectomy, for an early mastectomy rate of 6%. There were no early complications, nor cases of early implant loss. Long-term aesthetic results were evaluated using our 5-point scale: An excellent (5), or good (4) result was obtained in 68%. Significant capsular contracture (Baker grade 3 or 4) developed in 34%, of which, 5 women underwent capsulotomy and fat grafting; 4 of 5 downstaging their Baker grade. The estimated 5-year local recurrence rate was 2.3%. Ninety-five percent of participants would recommend BCT to augmented women.
BCT is feasible and safe in augmented women with good long-term aesthetic results, and should be considered to avoid unnecessary mastectomy.
女性乳房假体植入后乳腺癌的发病率越来越高。在过去的十年中，由于担心乳房体积小和放射引起的包膜挛缩会导致美容效果不佳，这些患者中掀起了乳房切除术和重建术的热潮。在巴黎乳房中心，接受过隆胸的女性通常会接受保乳手术联合全乳房放疗（BCT）。
回顾性分析了 2003 年至 2018 年间在我院尝试 BCT 治疗早期乳腺癌的 50 名接受过隆胸的连续队列患者。评估了治疗后并发症、肿瘤学结果、包膜挛缩率、长期美容效果和患者报告的结果。
中位随访时间为 51 个月。7 名患者（14%）的切缘受累，其中 4 名患者成功再次切除，3 名患者行乳房切除术，早期乳房切除术率为 6%。没有早期并发症，也没有早期假体丢失的病例。使用我们的 5 分制评估长期美容效果：68%的患者获得了优秀（5 分）或良好（4 分）的结果。34%的患者出现了显著的包膜挛缩（贝克 3 或 4 级），其中 5 名患者接受了包膜切开和脂肪移植术，其中 4 名患者的贝克分级降低。估计 5 年局部复发率为 2.3%。95%的参与者会向接受过隆胸的女性推荐 BCT。
BCT 在接受过隆胸的女性中是可行和安全的，且具有良好的长期美容效果，应考虑避免不必要的乳房切除术。
