Roubaud Margaret S, Carey Joseph N, Vartanian Emma, Patel Ketan M
Department of Plastic and Reconstructive Surgery, University of Texas, MD Anderson Cancer Center, Houston, TX, USA.
Department of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, CA, USA.
Gland Surg. 2021 Jan;10(1):479-486. doi: 10.21037/gs-2020-nfbr-09.
Breast reconstruction is an important part of the cancer treatment paradigm and the psychosocial benefits are well described in the literature. Notably, breast reconstruction restores both the functional and emotional losses patients experience due to tumor resection. Post-cancer quality of life is an important benchmark of successful treatment; therefore, breast reconstruction is an essential component that should be offered whenever possible. Over time, reconstructive techniques and outcomes have improved dramatically resulting in better patient safety and decreased operative morbidity. When counseling a patient for surgery, the provider must consider all aspects of a patient's health. Ideally, breast cancer patients should be physically, emotionally, and oncologically appropriate candidates for reconstruction. However, in concerted effort to provide opportunities for as many patients as possible, the definition of who is a good candidate for reconstruction has evolved to include higher risk patients. These patients include those with advanced age, nicotine use, obesity, and significant ptosis. With improvements in surgical procedures and perioperative care, this population may also benefit from restorative surgery. However, the exact risk of complications and necessary counseling has gone largely undefined in this population. This article examines particular "high-risk" groups that may be challenging for extirpative and reconstructive surgeons and offers current guidelines for practice.
乳房重建是癌症治疗模式的重要组成部分，其心理社会效益在文献中已有充分描述。值得注意的是，乳房重建可恢复患者因肿瘤切除而经历的功能和情感损失。癌症后的生活质量是成功治疗的重要基准；因此，乳房重建是应尽可能提供的重要组成部分。随着时间的推移，重建技术和效果有了显著改善，提高了患者安全性并降低了手术发病率。在为患者进行手术咨询时，医疗服务提供者必须考虑患者健康的各个方面。理想情况下，乳腺癌患者在身体、情感和肿瘤学方面都应是重建的合适人选。然而，为了齐心协力为尽可能多的患者提供机会，重建合适人选的定义已扩大到包括高风险患者。这些患者包括高龄、吸烟、肥胖和明显乳房下垂的患者。随着手术程序和围手术期护理的改进，这一人群也可能从修复手术中受益。然而，这一人群并发症的确切风险和必要的咨询在很大程度上尚未明确。本文探讨了可能给切除和重建外科医生带来挑战的特定“高风险”群体，并提供了当前的实践指南。
