Wolter Andreas, Fertsch Sonia, Lisboa Bjoern Wieland, Andree Christoph
Plastische und Ästhetische Chirurgie, Sana Krankenhaus Gerresheim, Düsseldorf, Germany.
Fakultät für Gesundheit, Universität Witten/Herdecke, Witten, Germany.
Handchir Mikrochir Plast Chir. 2022 Aug;54(4):279-296. doi: 10.1055/a-1826-2992. Epub 2022 Jun 21.
The ideal technical and chronological approach of breast reconstruction in case of planned radiotherapy after mastectomy (post-mastectomy radiotherapy, PMRT) continues to be controversially discussed.
The authors analysed the MEDLINE Database PubMed for relevant studies concerning PMRT and breast reconstruction. The main theses from these publications were extracted and summarised.
An implant-based approach is the least invasive technique for immediate breast-mound formation in a PMRT setting. Reconstruction in a PMRT setting with a two-stage expander-implant technique or expander-implant-autologous procedure can provide good to excellent cosmetic outcomes. In contrast to the implant-based approach, autologous reconstruction methods provide an improved quality of life as well as haptic and sensory advantages and are usually associated with lower complication rates. PMRT after autologous reconstruction can have a negative impact on the autologous tissue. A delayed autologous approach can be advantageous and should be generally favoured in high-risk patients.
Factors influencing a meticulous planning of breast reconstruction including PMRT are surgical, aesthetic and patient characteristics, quality of life, preference and expectation. Ideally, PMRT is completed before autologous reconstruction to avoid radiation-associated side-effects on the final reconstructive result. If PMRT is likely, but potentially not necessary, an immediate-delayed procedure may be of advantage.
对于乳房切除术后计划进行放疗（乳房切除术后放疗，PMRT）的患者，乳房重建的理想技术和时间方法仍存在争议。
作者分析了MEDLINE数据库中的PubMed，以查找有关PMRT和乳房重建的相关研究。提取并总结了这些出版物的主要论点。
在PMRT环境中，基于植入物的方法是立即形成乳房丘的侵入性最小的技术。在PMRT环境中采用两阶段扩张器-植入物技术或扩张器-植入物-自体组织手术进行重建可提供良好至极佳的美容效果。与基于植入物的方法相比，自体组织重建方法可改善生活质量，并具有触觉和感觉方面的优势，且通常并发症发生率较低。自体组织重建后进行PMRT可能会对自体组织产生负面影响。延迟自体组织重建方法可能具有优势，在高危患者中通常应优先考虑。
影响包括PMRT在内的乳房重建精细规划的因素有手术、美学和患者特征、生活质量、偏好和期望。理想情况下，在进行自体组织重建之前完成PMRT，以避免放疗对最终重建结果产生相关副作用。如果可能需要进行PMRT，但不一定必要，立即-延迟手术可能具有优势。
