Division of Plastic and Reconstructive Surgery, Saint Louis University School of Medicine, St. Louis, MO, USA.
Division of Plastic Surgery, Medical University of South Carolina, Charleston, SC, USA.
Aesthetic Plast Surg. 2023 Jun;47(3):905-911. doi: 10.1007/s00266-023-03257-7. Epub 2023 Feb 3.
Oncoplastic breast surgery is more likely to achieve superior aesthetic outcomes compared to lumpectomy alone. Oncoplastic reduction mammoplasty (ORM) is a volume displacement oncoplastic technique that combines lumpectomy and reduction mammoplasty. Data on aesthetic and quality-of-life (QoL) outcomes after ORM are scarce in the literature. Based on a literature review, this present study reports outcomes on the largest group of ORM patients to date.
A retrospective review was conducted of all patients who underwent ORM between 2011 and 2018 at a tertiary care centre. Patients were excluded if no pedicle information was available or did not undergo post-operative radiotherapy. All patients with available post-operative photographs were aesthetically evaluated by four blinded, independent investigators blinded based on breast symmetry, nipple symmetry, and overall appearance. The BREAST-Q (breast conserving module) was used to assess QoL outcomes.
Two-hundred-and-sixteen consecutive patients (223 breasts) were included. Macromastia (cup size D or higher) was present in 173 patients (80.1%). Inferior pedicle ORM was utilized in 179 (80.3%) breasts. Eighty-eight patients (40.7%) were aesthetically evaluated, of whom 69 patients (78.4%) had "good", "very good", or "excellent" grades in all aesthetic categories. Seventy-five patients (85.2%) had "good" or better grades in overall appearance. Preoperative ptosis grade, cup size, presence of post-operative complications, and breast specimen weight had no significant correlations with aesthetic grades. Inferior pedicle ORM was associated with a higher "satisfaction with breast" Q-score (p=0.017) compared to other pedicle approaches.
Inferior pedicle ORM achieves objectively excellent aesthetic outcomes and high patient satisfaction with the reconstruction.
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与单纯切除术相比，肿瘤整形乳房切除术更有可能获得更好的美容效果。肿瘤整形缩小乳房成形术（ORMP）是一种容积移位肿瘤整形技术，结合了肿块切除术和乳房缩小成形术。关于 ORMP 术后美容和生活质量（QoL）结果的数据在文献中很少。基于文献回顾，本研究报告了迄今为止最大的 ORMP 患者组的结果。
对 2011 年至 2018 年在一家三级护理中心接受 ORMP 的所有患者进行了回顾性审查。如果没有蒂信息或未接受术后放疗，则排除患者。所有有术后照片的患者均由四名独立的、盲目的调查员根据乳房对称性、乳头对称性和整体外观进行美学评估。使用 BREAST-Q（乳房保留模块）评估生活质量结果。
共纳入 216 例连续患者（223 侧乳房）。巨乳症（杯罩尺寸 D 或更大）见于 173 例患者（80.1%）。下蒂 ORMP 用于 179 例（80.3%）乳房。88 例（40.7%）患者进行了美学评估，其中 69 例（78.4%）在所有美学类别中均获得“良好”、“非常好”或“优秀”等级。75 例（85.2%）患者的整体外观获得“良好”或更好的等级。术前下垂程度、杯罩尺寸、术后并发症存在以及乳房标本重量与美学等级无显著相关性。下蒂 ORMP 与其他蒂方法相比，“对乳房的满意度”Q 评分更高（p=0.017）。
下蒂 ORMP 可获得客观上优异的美容效果和患者对重建的高度满意度。
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