Department of Breast Surgery, Norfolk and Norwich University Hospitals, Colney Lane, Norwich, NR4 7UY, United Kingdom.
Department of Breast Surgery, Norfolk and Norwich University Hospitals, Colney Lane, Norwich, NR4 7UY, United Kingdom.
Breast. 2022 Oct;65:104-109. doi: 10.1016/j.breast.2022.07.001. Epub 2022 Jul 18.
Breast conserving surgery (BCS) is associated with unsatisfactory cosmetic outcomes in up to 30% of patients, carrying psychological and quality-of-life implications. This study compares long-term cosmetic outcomes after BCS for breast cancer with v without simple oncoplastic defect closure.
A randomised controlled trial was performed, recruiting patients who underwent BCS over four years and randomising to the "reshaping" group (closure of excision defect with mobilised breast tissue; n = 124) and to the "control" group (no attempt at defect closure; n = 109). The estimated excision volume (EEV) was <20% of breast volume (BV) in both groups. Photography and breast retraction assessment (BRA) were recorded preoperatively. Cosmetic outcomes were blindly assessed annually for five years by BRA, panel assessment of patients, and body image questionnaire (BIQ).
There were no significant differences between the reshaping and control groups in mean age (52.4 v 53.0; p = 0.63), body mass index (27.8 v 27.7; p = 0.80), margin re-excision (9 v 9; p = 0.78), mean BV (562.5 v 590.3 cc; p = 0.56), mean EEV (54.6 v 60.1 cc; p = 0.14), mean EEV/BV ratio (11.2 v 11.0; p = 0.84), or mean specimen weight (52.1 v 57.7 g; p = 0.24). Reshaping group patients had significantly better outcomes compared to control group patients in terms of mean BRA (0.9 v 2.8; p < 0.0001), achieving a score of "good" or "excellent" by panel assessment at 5 years (75.8% v 48%, p < 0.0001), body image questionnaire top score at 5 years (66.9% v 35.8%; p = 0.0001).
Simple oncoplastic closure of defects after breast-conserving surgery improves long-term objective and subjective cosmetic outcomes.
保乳手术（BCS）在多达 30%的患者中存在不满意的美容效果，会对心理和生活质量产生影响。本研究比较了乳腺癌患者行 BCS 时是否采用简单的肿瘤整形缺陷闭合术对长期美容效果的影响。
本研究为随机对照试验，招募了四年内行 BCS 的患者，并将其随机分为“塑形”组（用移动的乳房组织闭合切除缺陷；n=124）和“对照组”（不尝试缺陷闭合；n=109）。两组的估计切除体积（EEV）均<20%的乳房体积（BV）。术前记录摄影和乳房回缩评估（BRA）。术后 5 年通过 BRA、患者小组评估和身体意象问卷（BIQ）对美容效果进行盲法评估。
在平均年龄（52.4 岁比 53.0 岁；p=0.63）、体重指数（27.8 比 27.7；p=0.80）、边缘再切除术（9 比 9；p=0.78）、平均 BV（562.5cc 比 590.3cc；p=0.56）、平均 EEV（54.6cc 比 60.1cc；p=0.14）、平均 EEV/BV 比值（11.2 比 11.0；p=0.84）或平均标本重量（52.1g 比 57.7g；p=0.24）方面，塑形组与对照组之间无显著差异。与对照组相比，塑形组患者的 BRA 评分明显更好（0.9 比 2.8；p<0.0001），5 年时通过小组评估达到“良好”或“优秀”的比例更高（75.8%比 48%，p<0.0001），5 年时 BIQ 得分最高（66.9%比 35.8%；p=0.0001）。
保乳手术后简单的肿瘤整形缺陷闭合可改善长期的客观和主观美容效果。
