Pitiyarachchi Omali, Phillips Kelly-Anne, Friedlander Michael
Department of Medical Oncology, Prince of Wales Hospital, Barker St, Randwick NSW 2031, Australia; Prince of Wales Clinical School, UNSW Medicine, Sydney, New South Wales, Australia.
Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; The Sir Peter MacCallum Department of Oncology, the University of Melbourne, Melbourne, Victoria, Australia.
Cancer Treat Res Commun. 2022;30:100504. doi: 10.1016/j.ctarc.2021.100504. Epub 2022 Jan 1.
After a diagnosis of breast cancer women with increased genetic risk often have a risk reducing contralateral mastectomy, and may opt for a nipple or skin sparing mastectomy with immediate reconstruction. A variable amount of residual breast tissue remains which may substantially increase in volume during pregnancy. Whether this increases later risk of breast cancer is unknown. We describe the clinical details of 3 patients with a history of unilateral breast cancer, including 2 with a BRCA mutation, who developed hyperplasia of residual breast tissue in the 3rd trimester of a later pregnancy. They all had a delayed contralateral risk reducing skin sparing mastectomy and immediate reconstruction. Pregnancy occurred some years later. We summarise their management, review the literature and raise questions for discussion. All developed prominent hyperplasia of breast tissue in the 3rd trimester that was clinically obvious asymmetrical breast swelling in the reconstructed contralateral breast. MRI demonstrated substantial breast tissue. The risk of breast cancer, particularly in those at high genetic risk developing in the residual breast tissue is unknown but in view of the volume, breast tissue was excised postpartum. This phenomenon of pregnancy induced hyperplasia of breast tissue after risk reducing mastectomy is not well described .There is residual breast tissue following a risk reducing subcutaneous mastectomy. The risk factors include age and skin flap thickness. MRI can demonstrate the residual breast tissue. Pregnancy induced hyperplasia of residual breast tissue may occur after risk reducing mastectomy with a hypothetical increased risk of subsequent breast cancer.
在被诊断出患有乳腺癌后，遗传风险增加的女性通常会进行降低风险的对侧乳房切除术，并且可能会选择保留乳头或皮肤的乳房切除术并立即进行重建。会残留一定量的乳腺组织，这些组织在怀孕期间可能会大量增加。目前尚不清楚这是否会增加日后患乳腺癌的风险。我们描述了3例有单侧乳腺癌病史患者的临床细节，其中包括2例携带BRCA突变的患者，她们在后来怀孕的第三个月出现了残留乳腺组织增生。她们都接受了延迟的对侧降低风险的保留皮肤乳房切除术并立即进行了重建。几年后她们再次怀孕。我们总结了她们的治疗情况，回顾了相关文献并提出了供讨论的问题。她们在怀孕第三个月时均出现了明显的乳腺组织增生，表现为重建的对侧乳房临床上明显的不对称肿胀。MRI显示有大量乳腺组织。残留乳腺组织发生乳腺癌的风险，尤其是在那些高遗传风险人群中尚不清楚，但鉴于其体积，产后切除了乳腺组织。降低风险乳房切除术后妊娠引起的乳腺组织增生这一现象尚未得到充分描述。降低风险的皮下乳房切除术后会有残留乳腺组织。风险因素包括年龄和皮瓣厚度。MRI可以显示残留乳腺组织。降低风险乳房切除术后可能会发生妊娠引起的残留乳腺组织增生，推测后续患乳腺癌的风险会增加。
