Ferrucci Massimo, Milardi Francesco, Passeri Daniele, Miglioranza Elena, Del Bianco Paola, Montagna Giacomo, Marchet Alberto
Breast Surgery Unit, Veneto Institute of Oncology IOV, IRCSS - Istituto di Ricovero e Cura a Carattere Scientifico, Padova, Italy.
Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy.
Ann Surg Oncol. 2025 Sep 12. doi: 10.1245/s10434-025-18281-x.
Intraoperative ultrasound-guided breast-conserving surgery (IOUS) combined with chest wall perforator flaps (CWPFs) is a promising approach to avoid mastectomy, especially for patients with high anticipated resection-to-breast volume ratios (ARR) who would otherwise be ineligible for breast conservation.
This study prospectively analyzed surgical, oncologic, and cosmetic outcomes for consecutive patients with stages 0 to III breast cancer who underwent IOUS with CWPF-based partial breast reconstruction at a single institution between 2022 and 2024.
The study enrolled 73 female patients. The median age was 57 years, and the median tumor size was 32 mm, with 43.8% of lesions being multifocal/multicentric. The median ARR was 30.2%. The flap types included lateral intercostal artery perforator (LiCAP, 53.4%), anterior intercostal artery perforator (AICAP, 8.2%), medial intercostal artery perforator (MICAP, 19.2%), lateral thoracic artery perforator (LTAP, 16.4%), and thoracodorsal artery perforator (TDAP, 2.7%). The median flap volume was 90 cm (interquartile range [IQR], 47-140.5 cm), corresponding to 127% of the median specimens' volume (71.1 cm). The median operation time was 112 min. The 30-day global complication rate was 16.4%. No flap losses occurred. The positive margin rate was 9.6%, requiring re-excisions (5.5%) and mastectomies (4.1%). Adjuvant radiotherapy was administered to 95.9% of the patients, with no flap-related complications. During a median follow-up period of 14 months, only one distant recurrence was experienced, and no deaths occurred. Both patient- and surgeon-assessed evaluations demonstrated excellent cosmetic outcomes. Lower scores were associated with postoperative complications, re-excisions, and horizontal scars. None of the patients would have preferred mastectomy, and 89% underwent CWPF-based surgery to avoid it.
The combination of IOUS and CWPFs yielded favorable surgical, cosmetic, and short-term oncologic outcome. This approach effectively and safely expands the indications for breast conservation, avoiding mastectomies, particularly for patients with small-to-medium breasts and an unfavorable ARR.
术中超声引导下保乳手术（IOUS）联合胸壁穿支皮瓣（CWPF）是一种有望避免乳房切除术的方法，尤其适用于预期切除与乳房体积比（ARR）较高、否则不符合保乳条件的患者。
本研究前瞻性分析了2022年至2024年期间在单一机构接受IOUS联合基于CWPF的部分乳房重建的0至III期乳腺癌连续患者的手术、肿瘤学和美容效果。
该研究纳入了73名女性患者。中位年龄为57岁，中位肿瘤大小为32毫米，43.8%的病变为多灶性/多中心性。中位ARR为30.2%。皮瓣类型包括肋间外侧动脉穿支（LiCAP，53.4%）、肋间前动脉穿支（AICAP，8.2%）、肋间内侧动脉穿支（MICAP，19.2%）、胸外侧动脉穿支（LTAP，16.4%）和胸背动脉穿支（TDAP，2.7%）。中位皮瓣体积为90立方厘米（四分位间距[IQR]，47 - 140.5立方厘米），相当于中位标本体积（71.1立方厘米）的127%。中位手术时间为112分钟。30天总体并发症发生率为16.4%。未发生皮瓣丢失。切缘阳性率为9.6%，需要再次切除（5.5%）和乳房切除术（4.1%）。95.9%的患者接受了辅助放疗，未出现与皮瓣相关的并发症。在中位随访期14个月期间，仅发生1例远处复发，无死亡病例。患者和外科医生评估均显示美容效果极佳。较低的评分与术后并发症、再次切除和水平瘢痕有关。没有患者愿意选择乳房切除术，89%的患者接受基于CWPF的手术以避免乳房切除术。
IOUS与CWPF联合应用产生了良好的手术、美容和短期肿瘤学效果。这种方法有效且安全地扩大了保乳的适应证，避免了乳房切除术，特别是对于中小乳房且ARR不利的患者。
