Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH, USA.
Ann Surg Oncol. 2024 Nov;31(12):8372-8382. doi: 10.1245/s10434-024-16003-3. Epub 2024 Aug 5.
Recommendations for breast surveillance following breast plastic surgery are frequently changing. Establishing guidelines for long-term monitoring protocols may help identify treatable conditions and prevent untoward sequelae. We sought to evaluate the current state of evidence-based long-term monitoring protocols for patients following breast augmentation, reduction, and breast reconstruction.
Official guidelines from various American societies and international societies were analyzed for alignment in evidence-based recommendations regarding breast surveillance.
The most recent US FDA update recommends magnetic resonance imaging or ultrasound starting 5-6 years after surgery and every 2-3 years thereafter. Discrepancies exist among professional societies: the American Society of Plastic Surgeons (ASPS) aligns with the FDA, while the American Society of Breast Surgeons and American College of Radiology (ACR) find no role for imaging for asymptomatic cases. Ultrasound is first-line for any implant concerns, with MRI if necessary. European societies oppose routine breast implant imaging. Breast reduction patients lack unique screening protocols; monitoring aligns with age and cancer risk factors. Following mastectomy and breast reconstruction, most organizations advocate for annual clinical examinations, with more frequent examinations initially. Evidence suggests that physical examination is sufficient to detect local cancer recurrence, with imaging only indicated if there is concern for recurrence. No surveillance imaging is recommended by the American Society of Clinical Oncology, National Comprehensive Cancer Network, or ASPS; however, ACR recommends mammography for autologous reconstruction only.
Multispecialty and regulatory body alignment may promote provider and patient adherence. Ongoing studies of long-term outcomes are needed to strengthen the level of evidence for monitoring guidelines.
乳房整形术后的乳房监测建议经常发生变化。制定长期监测方案的指南可以帮助识别可治疗的疾病，并防止不良后果。我们旨在评估乳房隆乳、缩小和乳房重建术后患者的基于循证的长期监测方案的现状。
分析了来自不同美国学会和国际学会的官方指南，以评估其在基于循证的乳房监测建议方面的一致性。
美国食品药品监督管理局（FDA）的最新更新建议在手术后 5-6 年开始进行磁共振成像或超声检查，此后每 2-3 年进行一次。专业学会之间存在差异：美国整形外科学会（ASPS）与 FDA 一致，而美国乳房外科学会和美国放射学会（ACR）认为对于无症状病例，影像学检查没有作用。对于任何植入物问题，首先进行超声检查，如果需要，则进行 MRI。欧洲学会反对常规乳房植入物成像。乳房缩小术患者缺乏独特的筛查方案；监测与年龄和癌症风险因素一致。乳房切除术后和乳房重建后，大多数组织都提倡每年进行临床检查，最初检查更频繁。有证据表明，体格检查足以检测局部癌症复发，如果怀疑复发，则仅需要进行影像学检查。美国临床肿瘤学会、国家综合癌症网络或 ASPS 均不推荐乳房监测成像；然而，ACR 仅建议对自体重建进行乳房 X 线摄影。
多学科和监管机构的一致性可能会促进提供者和患者的依从性。需要进行长期结果的研究，以加强监测指南的证据水平。
