Kroll S S, Miller M J, Schusterman M A, Reece G P, Singletary S E, Ames F
Department of Reconstructive and Plastic Surgery, University of Texas M.D. Anderson Cancer Center, Houston 77030.
Ann Surg Oncol. 1994 Nov;1(6):457-61. doi: 10.1007/BF02303609.
Women with breast cancer treated by mastectomy with immediate breast reconstruction can get exceptionally good results if the reconstruction is performed with autogenous tissue using the transverse rectus abdominis myocutaneous (TRAM) flap. Bilateral reconstruction with TRAM flaps is also possible, but only if both breasts are reconstructed at the same time. To avoid the possibility of subsequently developing contralateral malignancy and having to undergo assymetrical reconstruction with a different technique, some patients have chosen the alternative of bilateral mastectomy with bilateral immediate reconstruction. This is only reasonable if the incidence of failure in bilateral breast reconstruction is very low.
We prospectively studied reconstructive outcomes in 100 patients who had breast cancer and who underwent bilateral mastectomy and reconstruction (using implants as well as TRAM flaps). We also reviewed the histologic findings in 88 prophylactically removed high-risk breasts.
Successful outcomes were initially achieved in 95 patients; of the 5 failures, two were successfully reconstructed with alternative techniques for an overall success rate of 97%. Of the 63 patients reconstructed with bilateral TRAM flaps, all but one (98%) were successful on the first try. TRAM flap reconstructions were significantly more likely to be successful than were those based on implants (p = 0.05). Previously unsuspected invasive cancer was found in 3 patients (3.4%), whereas carcinoma in situ was found in 5 patients (5.7%) and in another 18 patients (20%) cellular atypia was present.
Bilateral breast reconstruction has a low incidence of failure, particularly if TRAM flaps are used. For selected patients, elective contralateral mastectomy with immediate bilateral reconstruction is a reasonable treatment alternative provided that the necessary expertise is available and the patients clearly understand the risks.
对于接受乳房切除术后即刻乳房重建的乳腺癌女性患者，如果采用自体组织通过横行腹直肌肌皮瓣（TRAM瓣）进行重建，能够获得非常好的效果。双侧TRAM瓣重建也是可行的，但前提是双侧乳房要同时进行重建。为了避免随后发生对侧恶性肿瘤以及不得不采用不同技术进行不对称重建的可能性，一些患者选择了双侧乳房切除并即刻双侧重建的替代方案。只有在双侧乳房重建失败率非常低的情况下，这种做法才是合理的。
我们前瞻性地研究了100例患有乳腺癌并接受双侧乳房切除及重建（使用植入物以及TRAM瓣）患者的重建结果。我们还回顾了88例预防性切除的高危乳房的组织学检查结果。
最初95例患者获得了成功的重建结果；在5例失败病例中，有2例通过替代技术成功重建，总体成功率为97%。在63例采用双侧TRAM瓣重建的患者中，除1例（98%）外其余均首次尝试成功。TRAM瓣重建比基于植入物的重建显著更有可能成功（p = 0.05）。在3例患者（3.4%）中发现了先前未被怀疑的浸润性癌，在5例患者（5.7%）中发现了原位癌，另有18例患者（20%）存在细胞异型性。
双侧乳房重建的失败率较低, 尤其是使用TRAM瓣时。对于选定的患者，在有必要的专业技术且患者清楚了解风险的情况下，选择性对侧乳房切除并即刻双侧重建是一种合理的治疗选择。
