Saint John's Cancer Institute, Providence Saint John's Health Center, Santa Monica, CA, USA.
Ann Surg Oncol. 2023 Oct;30(10):6135-6139. doi: 10.1245/s10434-023-13893-7. Epub 2023 Aug 3.
In the era of oncoplastic breast conserving-surgery (OBCS), cosmetic outcomes and the desire for symmetry have become essential elements of the surgical management of breast cancer (BC). The timing of contralateral symmetry procedures remains a controversial topic. Simultaneous symmetry procedures (SSP) in OBCS have not been routinely offered due to the perceived risk of delayed asymmetry, potentially increasing the need for delayed cosmetic revision. This study evaluates the rate of revision after SSP in patients undergoing OBCS.
We reviewed our institutional prospectively maintained database identifying all BC patients treated surgically since our introduction of oncoplastic surgery in 2018. We routinely offer SSP when appropriate. Descriptive statistics evaluated oncoplastic surgical techniques, SSP offerings and procedures, perioperative complications, and revision rates after treatment completion.
Between 2018 and 2022, 485 breast cancer patients underwent partial mastectomy, and 396 (82%) underwent OBCS. Of the 313 patients offered SSP, 272 (87%) accepted. The margin reexcision rate of this cohort was 20%. Of the 272 patients with SSP, 152 (56%) underwent intraoperative radiation therapy (IORT), and 105 (39%) had adjuvant external beam radiation therapy. Three patients (1%) experienced complications involving the symmetry side. No patients with complications experienced a delay in adjuvant therapies or requested cosmetic revisions. Three patients (1%) desired surgical revisions due to asymmetry.
Symmetry procedures at the time of OBCS are widely accepted by patients and rarely require delayed cosmetic revision. Simultaneous symmetry procedures should be routinely discussed with patients during the surgical planning of OBCS.
在肿瘤整形保乳手术（OBCS）时代，美容效果和对对称性的追求已成为乳腺癌（BC）外科治疗的重要组成部分。对侧对称性手术的时机仍然是一个有争议的话题。由于担心延迟性不对称的风险，OBCS 中的同期对称手术（SSP）尚未常规进行，这可能会增加对延迟性美容修复的需求。本研究评估了 OBCS 患者接受 SSP 后的修复率。
我们回顾了我们机构的前瞻性维护数据库，该数据库确定了自 2018 年引入肿瘤整形手术以来接受手术治疗的所有 BC 患者。我们常规提供适当的 SSP。描述性统计数据评估了肿瘤整形手术技术、SSP 提供和程序、围手术期并发症以及治疗完成后的修复率。
2018 年至 2022 年间，485 例乳腺癌患者接受了部分乳房切除术，其中 396 例（82%）接受了 OBCS。在 313 例接受 SSP 手术的患者中，272 例（87%）接受了 SSP。该队列的切缘再切除率为 20%。在接受 SSP 的 272 例患者中，152 例（56%）接受了术中放射治疗（IORT），105 例（39%）接受了辅助外部束放射治疗。3 例（1%）患者发生对称性手术并发症。无并发症患者延迟辅助治疗或要求美容修复。3 例（1%）患者因不对称要求手术修复。
OBCS 时的对称性手术被患者广泛接受，很少需要延迟美容修复。同期对称手术应在 OBCS 的手术规划中常规与患者讨论。
