Klenotic E, Ochoa D, Stephenson K, Croswell C, Sullivan S, Sherman A C, Henry-Tillman R
Division of Breast Surgical Oncology, Department of Surgery, University of Arkansas for Medical Sciences and the Winthrop P. Rockefeller Cancer Institute, Little Rock, AR, USA.
Department of General Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Breast J. 2024 Mar 25;2024:7349633. doi: 10.1155/2024/7349633. eCollection 2024.
Oncologic mastectomy in the setting of obesity poses challenges in achieving a flat closure that includes the lateral adiposity. The angel wing (AW) technique was developed to address this issue. We aim to demonstrate the safety of AW by evaluating incidence of arm lymphedema (AL) and decreased range of motion (dROM) in patients postmastectomy with and without the AW closure.
We performed a single-center retrospective cohort study at an academic referral center of patients who underwent mastectomy with and without the AW technique from May 2014 to October 2022. Those who received breast reconstruction (immediate or delayed), partial mastectomy, and male patients were excluded. The presence of postoperative AL and dROM was evaluated. Subgroup analysis was performed for patient factors including BMI, extent of axillary surgery, PMRT, and pathologic stage.
A total of 390 patients met inclusion criteria. Of those, 173 (44.4%) underwent AW and 217 (55.6%) had non-AW mastectomy. Expectedly, the average BMI was significantly higher in the AW cohort ( < 0.0001). The overall rate of AL was 51/390 (13.1%), seen in 27 (15.6%) undergoing AW and 24 (11.1%) non-AW ( value = 0.18). While the rate of dROM within the cohort was 52/390 (13.1%), 27 (15.6%) underwent AW vs. 24 (11.1%) non-AW ( value = 0.22), resulting in no statistical significance between AW and non-AW mastectomy upon subsequent development of AL or dROM.
Our study demonstrates the AW technique does not convey an increased risk of overall AL or dROM, even when considering known risk factors such as obesity, PMRT, and extent of axillary surgery. As we strive to provide our patients with improved surgical techniques for oncologic resection, we submit that this technique is a viable and safe option for achieving the goals of cosmesis with oncologic safety.
在肥胖患者中进行肿瘤性乳房切除术时，要实现包括外侧脂肪堆积的平整闭合存在挑战。天使翼（AW）技术就是为解决这一问题而开发的。我们旨在通过评估采用和未采用AW闭合术的乳房切除术后患者的手臂淋巴水肿（AL）发生率和活动范围减小（dROM）情况，来证明AW技术的安全性。
我们在一家学术转诊中心进行了一项单中心回顾性队列研究，研究对象为2014年5月至2022年10月期间接受或未接受AW技术乳房切除术的患者。排除接受乳房重建（即刻或延迟）、部分乳房切除术的患者以及男性患者。评估术后AL和dROM的存在情况。对包括体重指数（BMI）、腋窝手术范围、术后放疗（PMRT）和病理分期等患者因素进行亚组分析。
共有390例患者符合纳入标准。其中，173例（44.4%）接受了AW技术，217例（55.6%）进行了非AW乳房切除术。不出所料，AW队列中的平均BMI显著更高（<0.0001）。AL的总体发生率为51/390（13.1%），其中接受AW技术的患者中有27例（15.6%）出现，非AW技术患者中有24例（11.1%）出现（P值 = 0.18）。虽然队列中dROM的发生率为52/390（13.1%），接受AW技术的患者中有27例（15.6%），非AW技术患者中有24例（11.1%）（P值 = 0.22），因此在随后发生AL或dROM时，AW乳房切除术和非AW乳房切除术之间无统计学差异。
我们的研究表明，即使考虑到肥胖、PMRT和腋窝手术范围等已知风险因素，AW技术也不会增加总体AL或dROM的风险。在我们努力为患者提供改进的肿瘤切除手术技术时，我们认为该技术是实现美容目标并确保肿瘤安全性的一种可行且安全的选择。
