Schwartz Jean-Claude D
From the Gwinnett Surgical Specialists, LLC., Lawrenceville, Ga.
Plast Reconstr Surg Glob Open. 2023 Aug 16;11(8):e5211. doi: 10.1097/GOX.0000000000005211. eCollection 2023 Aug.
Centers of excellence strive for high rates of breast conservation surgery. Given the increased patient satisfaction, evidence for improved survival, decreased rates of complications, reduced costs, and fewer surgical procedures compared to mastectomy and reconstruction, this makes sense. As such, surgeons have devised approaches to offer breast conservation to patients with more extensive disease that would have been classically recommended to undergo mastectomy. These ambitious attempts at breast conservation are supported by recent studies that have established their oncological safety. "Extreme oncoplasty" refers to Wise-pattern volume displacement surgery where the breast is immediately reconstructed after a multifocal or multicentric breast cancer is excised. The authors that described this concept also described a Wise-pattern "split reduction" to allow for excision of the skin directly over the cancer, insuring a clear anterior margin. Although extreme oncoplasty has been broadly discussed and published on by many groups, there are few reports that provide insight into the surgical details necessary to successfully perform this surgery. Here, we combine three different oncoplastic techniques: the Wise-pattern split reduction, immediate nipple reconstruction, and autologous volume replacement to demonstrate our approach to extreme oncoplastic breast conservation in a challenging patient.
卓越中心致力于提高保乳手术的比例。鉴于与乳房切除术和重建术相比，保乳手术能提高患者满意度、有生存改善的证据、降低并发症发生率、降低成本且减少手术操作，这样做是有道理的。因此，外科医生已设计出方法，为那些传统上建议接受乳房切除术的患有更广泛疾病的患者提供保乳治疗。这些雄心勃勃的保乳尝试得到了近期研究的支持，这些研究证实了其肿瘤学安全性。“极限肿瘤整形术”指的是在切除多灶性或多中心性乳腺癌后立即对乳房进行重建的 Wise 模式容积置换手术。描述这一概念的作者还描述了一种 Wise 模式“分割缩小术”，以便直接切除肿瘤上方的皮肤，确保前缘切缘阴性。尽管极限肿瘤整形术已被许多团队广泛讨论和发表，但很少有报告深入探讨成功实施该手术所需的手术细节。在此，我们结合三种不同的肿瘤整形技术：Wise 模式分割缩小术、即时乳头重建术和自体容积置换术，以展示我们在一位具有挑战性的患者中进行极限肿瘤整形保乳手术的方法。
