Kiefer Jurij, Paidisetty Praneet, Elmorsi Rami A I, Nguyen Christopher H M, Yu Jessie Z, Hunt Kelly K, Lillemoe Heather A, Mericli Alexander F, Olenczak J Bryce
Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
J Surg Oncol. 2025 May;131(6):1013-1023. doi: 10.1002/jso.28042. Epub 2024 Dec 12.
Breast sarcomas are rare, heterogeneous malignancies often associated with prior radiation and require a multidisciplinary approach, including a comprehensive reconstruction plan. We analyzed reconstructive outcomes in a large cohort of patients with breast sarcomas and provide a contemporary treatment algorithm.
We retrospectively reviewed patients who underwent breast reconstruction after surgical treatment for breast sarcoma at our institution between January 2010 and December 2023. We analyzed patient and tumor characteristics, oncologic treatments, reconstructive approaches, and outcomes.
Eighty patients underwent 81 reconstructions. The median age at diagnosis was 53 years. The most common subtypes were primary angiosarcoma (35.8%) and radiation-associated angiosarcoma (33.3%). The median follow-up was 23 months. Oncologic management was multimodal: 63.0% received preoperative chemotherapy, 59.3% received post-operative chemotherapy, 35.8% received both pre- and post-operative chemotherapy, and 34.6% received pre- or post-operative radiation therapy. Forty-three (53.1%) patients underwent total mastectomy with or without chest wall resection requiring soft-tissue reconstruction. Thirty-eight (46.9%) patients underwent formal breast reconstruction. Autologous reconstructions included local tissue rearrangement (39.5%), pedicled flaps (18.5%), regional flaps (16.0%), and free flaps (13.6%). Most patients (82.7%) underwent immediate reconstruction.
Breast sarcomas are managed with multimodal therapy, and most patients undergo immediate reconstruction. Autologous reconstruction remains the first choice in radiated patients, however implant-based reconstruction has increased with modern approaches. Complication rates are acceptable and similar across sarcoma subtypes. Breast reconstruction is an essential component of care for these patients and can be performed safely and with good results.
乳腺肉瘤是罕见的异质性恶性肿瘤，常与既往放疗相关，需要多学科方法，包括全面的重建计划。我们分析了一大群乳腺肉瘤患者的重建结果，并提供了一种当代治疗算法。
我们回顾性分析了2010年1月至2023年12月在我院接受乳腺肉瘤手术治疗后进行乳房重建的患者。我们分析了患者和肿瘤特征、肿瘤治疗、重建方法和结果。
80例患者进行了81次重建。诊断时的中位年龄为53岁。最常见的亚型是原发性血管肉瘤（35.8%）和放疗相关血管肉瘤（33.3%）。中位随访时间为23个月。肿瘤管理是多模式的：63.0%接受术前化疗，59.3%接受术后化疗，35.8%接受术前和术后化疗，34.6%接受术前或术后放疗。43例（53.1%）患者接受了全乳切除术，伴或不伴胸壁切除，需要软组织重建。38例（46.9%）患者进行了正规的乳房重建。自体重建包括局部组织重排（39.5%）、带蒂皮瓣（18.5%）、区域皮瓣（16.0%）和游离皮瓣（13.6%）。大多数患者（82.7%）进行了即刻重建。
乳腺肉瘤采用多模式治疗，大多数患者进行即刻重建。自体重建仍然是放疗患者的首选，然而基于植入物的重建随着现代方法的应用有所增加。并发症发生率是可接受的，且在肉瘤亚型之间相似。乳房重建是这些患者护理的重要组成部分，可以安全地进行并取得良好效果。
