Fahradyan Artur, Liu Alice, Taylor Lesley, Jones Veronica, Li Wai-Yee
From the Division of Plastic and Reconstructive Surgery.
Keck School of Medicine, University of Southern California, Los Angeles.
Ann Plast Surg. 2022 May 1;88(4 Suppl 4):S366-S373. doi: 10.1097/SAP.0000000000003140.
Patients with locally advanced invasive breast cancer (LABC) are often considered inoperable, because of the anticipated chest wall defect and need for complex reconstruction. We present a series of patients who underwent mastectomy with extensive skin resection and immediate chest wall reconstruction using a local thoracoabdominal advancement flap (TAAF). All patients were managed after surgery with an ERAS (Enhanced Recovery After Surgery) protocol, to decrease length of stay in hospital. We also present 1 patient who subsequently had satisfactory bilateral delayed breast reconstruction with pedicled latissimus dorsi myocutaneous flaps with prepectoral silicone implants.
This is a single-surgeon, single-institution retrospective chart review of patients with LABC who underwent mastectomy with skin resection and local TAAF from May 2017 to October 2019, with minimum 3-month follow-up.
Thirteen patients met inclusion criteria. Twelve of 13 patients presented with stage III or IV invasive breast cancer, with skin involvement. The mean chest wall defect measured 248.7 cm2 (140-336 cm2; SD, 63.2 cm2), and all were successfully reconstructed with immediate local TAAF. There were no intraoperative complications, but 1 patient developed a postop hematoma. The mean hospital stay was 1.3 nights, with 9 patients (69.2%) staying less than 23 hours and 4 patients (30.8%) staying 2 nights. Nine patients (69.2%) underwent adjuvant therapy, beginning on average 32 days (13-55 days; SD, 13.1 days) after surgery. The mean follow-up time was 13.8 months (4.5-31.6 months; SD, 9.2 months). One patient underwent successful delayed bilateral breast reconstruction with pedicled latissimus dorsi myocutaneous flaps and silicone implant placement.
Our study demonstrates that reconstruction with local TAAF is an outpatient procedure that reliably provides durable, immediate chest wall coverage, after mastectomy in patients with LABC. This technique has a short operative time, low blood loss, and low complication rate, allowing timely adjuvant therapy. Using an ERAS postop protocol we were able to reduce mean hospital stay to 1.3 days. Compared with other described techniques of reconstruction, the additional scars and donor site morbidity are minimal, allowing for delayed breast reconstruction. We also present survival outcomes data on these surgically managed patients.
局部晚期浸润性乳腺癌（LABC）患者常被认为无法手术，因为预期存在胸壁缺损且需要复杂的重建。我们报告了一系列接受乳房切除术并广泛切除皮肤，随后使用局部胸腹推进皮瓣（TAAF）即刻进行胸壁重建的患者。所有患者术后均按照加速康复外科（ERAS）方案进行管理，以缩短住院时间。我们还报告了1例患者，其随后使用带蒂背阔肌肌皮瓣联合胸前区硅胶植入物进行了双侧延迟乳房重建，效果令人满意。
这是一项由单一外科医生在单一机构进行的回顾性病历审查，研究对象为2017年5月至2019年10月期间接受乳房切除术并切除皮肤及局部TAAF重建的LABC患者，随访时间至少3个月。
13例患者符合纳入标准。13例患者中有12例表现为III期或IV期浸润性乳腺癌，伴有皮肤受累。平均胸壁缺损面积为248.7平方厘米（140 - 336平方厘米；标准差，63.2平方厘米），所有患者均通过即刻局部TAAF成功重建。术中无并发症发生，但有1例患者术后出现血肿。平均住院时间为1.3晚，9例患者（69.2%）住院时间少于23小时，4例患者（30.8%）住院2晚。9例患者（69.2%）接受了辅助治疗，平均在术后32天（13 - 55天；标准差，13.1天）开始。平均随访时间为13.8个月（4.5 - 31.6个月；标准差，9.2个月）。1例患者使用带蒂背阔肌肌皮瓣联合硅胶植入物成功进行了双侧延迟乳房重建。
我们的研究表明，对于LABC患者，局部TAAF重建是一种门诊手术，能可靠地在乳房切除术后即刻提供持久的胸壁覆盖。该技术手术时间短、失血少、并发症发生率低，可使辅助治疗及时进行。采用ERAS术后方案，我们能够将平均住院时间缩短至1.3天。与其他描述的重建技术相比，额外的瘢痕和供区并发症极少，允许进行延迟乳房重建。我们还展示了这些接受手术治疗患者的生存结果数据。
