Department of Breast and Endocrine Surgery, Royal Adelaide Hospital, South Australia, Australia.
Department of Breast and Endocrine Surgery, The Tweed Hospital, New South Wales, Australia.
Breast Dis. 2022;41(1):267-272. doi: 10.3233/BD-210062.
Immediate autologous breast reconstruction (IABR) offers fewer surgeries with better psychosocial, quality of life and aesthetic outcomes. In high-risk patients or those with locally advanced breast cancer (LABC), adjuvant postmastectomy radiotherapy decreases local recurrence and improves survival. However, it has negative effects on the reconstructed flap. Reversing the treatment protocol using neoadjuvant radiotherapy may minimise the negative effects on the reconstructed breast in women requesting IABR. We assessed the safety and efficacy of women who underwent mastectomy and IABR post-neoadjuvant chemoradiotherapy (NACRT) for LABC.
A cohort study using a retrospective and prospective analysis was performed on women with LABC who underwent mastectomy and IABR post-NACRT between 1998 and 2018. All reconstructions were performed by oncoplastic breast surgeons from a single unit. Outcome measures analysed included surgical complications, flap failure, loco-regional recurrence, overall and disease-free survival. This study was conducted in accordance with the Declaration of Helsinki (as revised in 2013). This study was approved by the institutional review board.
A total of 28 women with a median age of 50 (33-64) were included. 25% underwent TRAM flap and 75% underwent LD flap reconstruction. The median period of follow-up was 61 months. Post-NACRT, 35.7% achieved complete pathological response (PCR). 3/28 (10.7%) had early complications (2 implant and 1 donor site infection). 7% underwent revision surgery. There was no flap loss. 1/28 (3.5%) had loco-regional recurrence, 3.2% had distant metastasis, and 2.5% had breast cancer related mortality.
In women with LABC, NACRT followed by mastectomy and IABR is safe and may not compromise oncological and cosmetic outcomes. If offers the benefits of immediate breast reconstruction and avoids delaying adjuvant therapy.
即刻自体乳房重建（IABR）可减少手术次数，并带来更好的社会心理、生活质量和美学效果。在高危患者或局部晚期乳腺癌（LABC）患者中，辅助乳房切除术后放疗可降低局部复发率并提高生存率。然而，它会对重建皮瓣产生负面影响。在要求进行 IABR 的女性中，采用新辅助放疗来逆转治疗方案，可能会使重建乳房受到的负面影响最小化。我们评估了接受新辅助放化疗（NACRT）后乳房切除术和 IABR 治疗 LABC 的女性的安全性和疗效。
回顾性和前瞻性分析了 1998 年至 2018 年间接受 NACRT 后乳房切除术和 IABR 的 LABC 女性的队列研究。所有重建均由单一单位的肿瘤整形乳房外科医生进行。分析的结果包括手术并发症、皮瓣失败、局部区域复发、总生存和无病生存。本研究符合赫尔辛基宣言（2013 年修订版）的规定。本研究获得了机构审查委员会的批准。
共纳入 28 名中位年龄为 50 岁（33-64 岁）的女性。25%接受了 TRAM 皮瓣重建，75%接受了 LD 皮瓣重建。中位随访时间为 61 个月。NACRT 后，35.7%达到完全病理缓解（PCR）。28 例中有 3 例（10.7%）发生早期并发症（2 例为植入物相关感染，1 例为供区感染）。7%接受了修正手术。无皮瓣坏死。28 例中有 1 例（3.5%）发生局部区域复发，3.2%发生远处转移，2.5%发生乳腺癌相关死亡。
对于 LABC 患者，NACRT 后行乳房切除术和 IABR 是安全的，不会影响肿瘤学和美容效果。它提供了即刻乳房重建的益处，并避免了辅助治疗的延迟。
