Breast Cancer Radiation Therapy Unit, at Sheba Medical Center, Ramat Gan, Israel; GROW-School for Oncology and Developmental Biology (Maastro), Maastricht University, The Netherlands; Sackler School of Medicine, Tel-Aviv University, Israel.
Sackler School of Medicine, Tel-Aviv University, Israel; General Surgery B and The Meirav Breast Center, Sheba Medical Center.
Radiother Oncol. 2021 Apr;157:263-271. doi: 10.1016/j.radonc.2021.01.036. Epub 2021 Feb 12.
Breast reconstruction and oncoplastic surgery have become an important part of breast cancer care. The use of autologous breast reconstruction (ABR) has evolved significantly with advances in microsurgery, aiming to reduce donor site complications and improve cosmesis. For years, immediate-ABR was considered a contraindication if postmastectomy irradiation (PMRT) was planned. As a result of de-escalation of axillary surgery the indication of PMRT are increasing along-side with observations that PMRT in the setting of ABR is not contraindicated. Surgical techniques may result in different amount and areas of breast residual glandular tissue and patient selection is important to reduce potential residual disease. Meticulus radiation planning is important to potentially reduce complications without compromising oncologic outcomes. Surgical techniques change constantly in aim to improve aesthetic results but should most importantly maintain priority to the oncological indications. By multidisciplinary team work with a comprehensive understanding of each discipline, we can preserve the accomplishments of breast surgery in the setting of PMRT, without compromising disease control.
乳房重建和肿瘤整形手术已成为乳腺癌治疗的重要组成部分。随着显微外科技术的进步，自体乳房重建（ABR）的应用有了显著的发展，旨在减少供区并发症并改善美容效果。多年来，如果计划进行乳房切除术放疗（PMRT），则即刻 ABR 被认为是禁忌症。由于腋窝手术的降级，随着观察到在 ABR 背景下 PMRT 不是禁忌症，PMRT 的适应证也在增加。手术技术可能导致乳房残留腺体组织的数量和区域不同，患者选择对于减少潜在的残留疾病很重要。精细的放射治疗计划对于在不影响肿瘤学结果的情况下降低并发症的风险很重要。为了改善美容效果，手术技术不断变化，但最重要的是应保持对肿瘤学适应证的优先考虑。通过多学科团队合作，全面了解每个学科，可以在 PMRT 背景下保留乳房手术的成就，而不会影响疾病控制。
