Department of Surgery, Faculty of Medical Sciences, University of Sri Jayawardenapura, Nugegoda, Sri Lanka.
Department of Surgery, National Hospital of Sri Lanka, Colombo, Sri Lanka.
BMC Surg. 2023 Sep 11;23(1):273. doi: 10.1186/s12893-023-02182-5.
Breast aesthetics is becoming increasingly important in breast cancer surgery due to changes in patient expectations and greater emphasis been placed on the psychosocial outcomes. Studies have shown no difference in local recurrence risk between mastectomy and breast conserving surgery (BCS) and also a higher overall survival rate after BCS. Breast preservation improves the quality of life substantially compared to mastectomy. Oncoplastic breast-conserving surgery (O-BCS) involves tumour excision whilst overcoming the limitations of standard breast conserving surgery (S-BCS) by allowing larger resection volumes, avoiding deformities with better aesthetic results. Our study aims to compare the oncosurgical and aesthetic outcomes of O-BCS versus S-BCS among women in Sri Lanka.
We conducted a retrospective study over a 4-year period including patients who underwent breast conservation surgery for primary non-metastatic breast cancer in two tertiary care units. We assessed outcomes in terms of re-excision rates, resection margin, complications and aesthetic outcomes using a Likert scale questionnaire to grade specific outcomes such as symmetry, volume, nipple position, scar visibility. Non-parametric tests were used for statistical analyses.
Fifty-four and seventy-three patients underwent S-BCS and O-BCS respectively. The median specimen volume and the maximum tumour diameter were significantly higher in O-BCS [160(range:65-220); 4.2(range: 1.2-5.2)] compared to S-BCS [65(range:45-86); 2.4(range: 1.0-2.6)]. The median closest tumour margin was 16 mm (range:4-25 mm) in O-BCS while 6 mm (range:<1 - 12 mm) in S-BCS (p = 0.01). Close (< 1 mm) and positive margins needing re-excision were seen mostly in S-BCS. Superior aesthetic outcomes with statistical significant difference were reported in the O-BCS compared to S-BCS group with better symmetry, volume, nipple position and scar visibility. The re-excision rates were significantly lower in O-BCS group. There was no significant difference in the operative time and complications while the aesthetic outcomes were significantly superior in OBCS.
Overall, Level 2 perforator flap based reconstruction had superior aesthetic outcomes. O-BCS is safe and more aesthetically acceptable with no difference in oncological outcome and operative time. More consideration should be given to aesthetic parameters such as scar visibility, nipple position, breast volume and shape when considering the best surgical option for the patients.
由于患者期望的变化和对社会心理结果的重视程度增加，乳腺癌手术中的乳房美学变得越来越重要。研究表明，乳房切除术与保乳手术（BCS）之间在局部复发风险方面没有差异，并且 BCS 后的总生存率更高。与乳房切除术相比，乳房保留显著提高了生活质量。肿瘤整形保乳术（O-BCS）涉及肿瘤切除，同时通过允许更大的切除体积、避免畸形和更好的美容效果来克服标准保乳术（S-BCS）的局限性。我们的研究旨在比较斯里兰卡女性中 O-BCS 与 S-BCS 的肿瘤外科和美容结果。
我们进行了一项回顾性研究，时间跨度为 4 年，包括在两个三级保健单位接受原发性非转移性乳腺癌保乳手术的患者。我们使用 Likert 量表问卷评估了再切除率、切缘、并发症和美容结果等方面的结果，以对特定结果（如对称性、体积、乳头位置、疤痕可见度）进行分级。使用非参数检验进行统计分析。
54 例患者接受了 S-BCS，73 例患者接受了 O-BCS。O-BCS 中的中位标本体积和最大肿瘤直径明显更高[160（范围：65-220）；4.2（范围：1.2-5.2）]，而 S-BCS 中则为[65（范围：45-86）；2.4（范围：1.0-2.6）]。O-BCS 中最近肿瘤切缘的中位数为 16 毫米（范围：4-25 毫米），而 S-BCS 中为 6 毫米（范围：<1-12 毫米）（p=0.01）。S-BCS 中大多数为近距离（<1 毫米）和阳性切缘需要再次切除，而 O-BCS 中则为近距离（<1 毫米）和阳性切缘需要再次切除。O-BCS 组报告的美容结果明显优于 S-BCS 组，具有统计学意义，表现为对称性、体积、乳头位置和疤痕可见度更好。O-BCS 组的再切除率明显较低。手术时间和并发症无显著差异，而 OBCS 的美容效果明显更好。
总体而言，基于 2 级穿支皮瓣的重建具有更好的美容效果。O-BCS 是安全的，并且在美容方面更能被接受，在肿瘤学结果和手术时间方面没有差异。在考虑患者最佳手术选择时，应更多地考虑美容参数，如疤痕可见度、乳头位置、乳房体积和形状。
