Agrawal Sanjit Kumar, Shakya Sudip Ratna, Nigam Shashank, Sharma Abhishek, Datta Soumitra S, Ahmed Rosina
Department of Breast Oncosurgery, Tata Medical Center, Kolkata 700156, India.
Department of Palliative Care and Psycho-Oncology, Tata Medical Center, Kolkata 700156, India.
Ecancermedicalscience. 2020 Jul 17;14:1073. doi: 10.3332/ecancer.2020.1073. eCollection 2020.
Partial breast reconstruction using chest wall perforator flaps (CWPF) is a recent option used by breast surgeons, mainly for lateral quadrant defects with a relatively large volume of excision. We report a single-centre experience of CWPF with surgery details, complications, re-excision, aesthetic and oncological outcomes. This was a prospective observational cohort study of patients who had undergone breast conservation surgery (BCS) plus CWPF reconstruction. All variables were recorded prospectively in the institutional database. A survey was done to analyse patient satisfaction at about 6 months after completion of radiotherapy. Forty patients had CWPF based reconstruction in 3 years. 57.5 % of patients had lateral intercostal artery perforator (LICAP) flap, 5% had lateral thoracic artery perforator (LTAP) flap, 27.5% had combined LICAP plus LTAP and 10% patients had anterior intercostal artery perforator (AICAP) flap. Tumour excision cavity defect was of the lateral quadrant in 82.5%, central quadrant in 10% and medial quadrant in 7.5% of patients. The margin was positive for five patients, out of which four required cavity shave and one had a mastectomy. One patient had complete flap loss, and two patients developed surgical site infection. 96% of patients were satisfied with the scar, and 88% were happy with the treated breast in comparison to the opposite breast. 92% were comfortable going out in public and felt that in retrospect their decision not to have a mastectomy was correct. With a median follow up of 18 (10, 22) months, one patient died, and four had recurrences. CWPF may be used for partial breast reconstruction in the small non-ptotic breast with excellent outcome and high patient satisfaction scores.
使用胸壁穿支皮瓣（CWPF）进行部分乳房重建是乳腺外科医生最近采用的一种方法，主要用于切除量相对较大的外侧象限缺损。我们报告了一项单中心CWPF的经验，包括手术细节、并发症、再次切除、美学和肿瘤学结果。这是一项对接受保乳手术（BCS）加CWPF重建患者的前瞻性观察队列研究。所有变量均前瞻性记录在机构数据库中。在放疗完成后约6个月进行了一项调查，以分析患者满意度。40例患者在3年内接受了基于CWPF的重建。57.5%的患者采用肋间外侧动脉穿支（LICAP）皮瓣，5%采用胸外侧动脉穿支（LTAP）皮瓣，27.5%采用LICAP加LTAP联合皮瓣，10%的患者采用肋间前动脉穿支（AICAP）皮瓣。82.5%的患者肿瘤切除腔缺损位于外侧象限，10%位于中央象限，7.5%位于内侧象限。5例患者切缘阳性，其中4例需要进行腔隙切除，1例进行了乳房切除术。1例患者皮瓣完全坏死，2例患者发生手术部位感染。96%的患者对瘢痕满意，88%的患者对患侧乳房与对侧乳房相比感到满意。92%的患者在公共场合外出感到自在，并认为回顾起来他们不进行乳房切除术的决定是正确的。中位随访时间为18（10，22）个月，1例患者死亡，4例复发。CWPF可用于小型不下垂乳房的部分乳房重建，效果良好，患者满意度高。
