From the Division of Surgery, Departments of Plastic Surgery and Breast Surgical Oncology, and the Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center.
Plast Reconstr Surg. 2020 Jul;146(1):14-27. doi: 10.1097/PRS.0000000000006911.
Volume replacement oncoplastic breast-conserving surgery (VR-OBCS) uses islanded or pedicled chest wall fasciocutaneous perforator flaps from outside of the breast footprint to replace the volume that has been excised during lumpectomy, extending the options for breast conservation to patients who may otherwise require mastectomy. This study compares outcomes for VR-OBCS with both standard volume displacement oncoplastic breast-conserving surgery (VD-OBCS) and mastectomy with immediate total breast reconstruction (TBR).
A retrospective cohort study was conducted; demographic data, clinicopathologic factors, surgical details, and postoperative events were collected until patients had completed their reconstructions. Variables were compared using the t test and analysis of variance test, or chi-square analysis and Fisher's exact test, as appropriate.
Ninety-seven consecutive patients (109 immediate breast reconstruction procedures) were included: 43 percent underwent standard VD-OBCS procedures, 35 percent underwent mastectomy with immediate TBR, and VR-OBCS techniques were used in 22 percent, of which only one patient required a delayed procedure for symmetry. Mean whole tumor size was similar in the VR-OBCS and TBR groups and was significantly higher than for the VD-OBCS group (p < 0.05). Overall rate of complications affecting the breast area (p < 0.001), need for additional surgery to either breast (p < 0.001), and time to reconstruction completion (p < 0.001) were significantly higher in the TBR group.
VR-OBCS extends the options for breast conservation to many patients that would otherwise require mastectomy. The complication rate is lower, fewer procedures are necessary, and less time is required to complete the reconstruction when compared with mastectomy and immediate TBR.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
容积置换肿瘤整形保乳术（VR-OBCS）采用岛状或带蒂胸壁筋膜皮穿支皮瓣，从乳房足迹之外的部位置换在保乳切除术过程中切除的体积，从而为可能需要乳房切除术的患者提供了更多的保乳选择。本研究比较了容积置换肿瘤整形保乳术（VR-OBCS）与标准容积移位肿瘤整形保乳术（VD-OBCS）和乳房切除术联合即刻全乳房重建（TBR）的治疗效果。
进行了一项回顾性队列研究；收集了人口统计学数据、临床病理因素、手术细节和术后事件，直到患者完成重建。使用 t 检验和方差分析或卡方检验和 Fisher 精确检验来比较变量，具体取决于适当情况。
纳入了 97 例连续患者（109 例即刻乳房重建手术）：43%的患者接受了标准的 VD-OBCS 手术，35%的患者接受了乳房切除术联合即刻 TBR，22%的患者接受了 VR-OBCS 技术，其中仅 1 例患者需要进行对称性延迟手术。VR-OBCS 和 TBR 组的整个肿瘤大小相似，显著高于 VD-OBCS 组（p < 0.05）。影响乳房区域的总体并发症发生率（p < 0.001）、对乳房进行额外手术的需要（p < 0.001）和重建完成时间（p < 0.001）在 TBR 组中显著更高。
VR-OBCS 将保乳选择扩展到许多原本需要乳房切除术的患者。与乳房切除术和即刻 TBR 相比，其并发症发生率较低，所需手术较少，重建完成时间较短。
临床问题/证据水平：治疗性，III 级。
