Martín-Merino Acera María Del Rosario, Colmenarejo García Esther, Ferrero San Román Carla, Valdazo Gómez Adela, Sánchez Egido Iris, Latorre Marlasca Lucía, Paseiro Crespo Gloria
Breast Surgery Section, General and Digestive Surgery Department, Hospital Universitario Infanta Leonor, Madrid, Spain; General and Digestive Surgery Department, Hospital Universitario Infanta Leonor, Madrid, Spain.
Breast Surgery Section, General and Digestive Surgery Department, Hospital Universitario Infanta Leonor, Madrid, Spain; General and Digestive Surgery Department, Hospital Universitario Infanta Leonor, Madrid, Spain.
Surgery. 2025 Oct;186:109586. doi: 10.1016/j.surg.2025.109586. Epub 2025 Aug 6.
Chest wall perforator flaps are increasingly used as volume replacement techniques in breast-conserving surgery for patients with unfavorable tumor-to-breast ratios or limited remodeling capacity. Their oncologic safety and complication profile compared to other standard techniques remain under evaluation.
We conducted a retrospective comparative observational study of 346 patients undergoing breast cancer surgery between 2020 and 2024. Patients were divided into 4 groups: chest wall perforator flap reconstruction (n = 36), lumpectomy without reshaping (n = 161), lumpectomy with oncoplastic mammoplasty (n = 69), and mastectomy with or without immediate reconstruction (n = 80). Surgical complications were classified using Clavien-Dindo. Re-excision rates, local recurrence, and patient satisfaction (BREAST-Q) were evaluated.
Chest wall perforator flap patients had a complication rate of 11.1%, comparable to lumpectomy (11.8%) and oncoplastic mammoplasty (11.6%), and lower than mastectomy with reconstruction (23.1%). The re-excision rate in chest wall perforator flap was 13.9%, compared with 19.3% in lumpectomy and 17.4% in oncoplastic cases. No local or distant recurrences were observed in chest wall perforator flap patients during a mean follow-up of 21.4 months. Patient satisfaction in the chest wall perforator flap group was high, with 86.1% reporting favorable cosmetic outcomes.
Chest wall perforator flap reconstruction offers complication and re-excision rates comparable to other surgical techniques, with excellent short-term oncologic safety and high patient satisfaction. They are a valuable option for selected patients undergoing breast-conserving surgery, particularly when tumor size or location limits the use of standard approaches.
对于肿瘤与乳房比例不佳或重塑能力有限的患者，胸壁穿支皮瓣越来越多地被用作保乳手术中的容积替代技术。与其他标准技术相比，其肿瘤学安全性和并发症情况仍在评估中。
我们对2020年至2024年间接受乳腺癌手术的346例患者进行了一项回顾性比较观察研究。患者分为4组：胸壁穿支皮瓣重建组（n = 36）、单纯乳房切除术组（n = 161）、肿瘤整形乳房成形术组（n = 69）以及乳房切除术伴或不伴即刻重建组（n = 80）。手术并发症采用Clavien-Dindo分类法。评估再次切除率、局部复发情况以及患者满意度（BREAST-Q）。
胸壁穿支皮瓣患者的并发症发生率为11.1%，与单纯乳房切除术（11.8%）和肿瘤整形乳房成形术（11.6%）相当，低于乳房切除术伴重建（23.1%）。胸壁穿支皮瓣的再次切除率为13.9%，单纯乳房切除术为19.3%，肿瘤整形病例为17.4%。在平均21.4个月的随访期间，胸壁穿支皮瓣患者未观察到局部或远处复发。胸壁穿支皮瓣组患者满意度较高，86.1%的患者报告美容效果良好。
胸壁穿支皮瓣重建的并发症和再次切除率与其他手术技术相当，具有出色的短期肿瘤学安全性和较高的患者满意度。对于选择保乳手术的特定患者，尤其是肿瘤大小或位置限制了标准方法使用时，它们是一种有价值的选择。
