Guenther J M, Tokita K M, Giuliano A E
Joyce Eisenberg Keefer Breast Center, John Wayne Cancer Institute at Saint John's Hospital and Health Center, Santa Monica, California 90404.
Cancer. 1994 May 15;73(10):2613-8. doi: 10.1002/1097-0142(19940515)73:10<2613::aid-cncr2820731024>3.0.co;2-9.
Although breast-conserving therapy (tumor excision, axillary node dissection, and postoperative radiation) for women with breast cancer yields survival and local recurrence rates comparable with those of modified radical mastectomy, studies suggest that postoperative radiation leads to capsular contractures and poor cosmesis in patients with breast implants.
The authors followed 20 women in whom breast cancer developed after augmentation mammoplasty (14 subcutaneous implants and 6 retromuscular implants). Average age at diagnosis was 52 years (range, 34-72 years). Most (55%) of the patients had tumors in the upper outer quadrant. Fifteen lesions were palpable and five were nonpalpable. All tumors were excised using wide margins that attempted to include a rim of normal breast tissue. Three patients had microscopically positive margins. The predominant histology was ductal adenocarcinoma (85%). The mean greatest tumor dimension was 1.43 cm; 75% were T1 lesions. Levels I and II axillary lymph node dissection revealed metastases in five patients. After surgery, six patients received systemic chemotherapy, and all patients received 4500-5000 cGy of tangential photon radiation delivered to the whole breast, plus a 1400-2100 cGy boost delivered to the tumor site using photon radiation, electron radiation, or iridium 192 implantation.
At a median follow-up of 3.8 years (range, 6 months to 9.3 years), there were no local recurrences; however, in two patients distant metastases developed. Seventeen (85%) of the twenty patients had good or excellent cosmetic results as determined by the degree of capsular contracture, breast shape and appearance, and the presence of skin changes.
The authors conclude that breast-conserving therapy is a cosmetically acceptable therapeutic option for women in whom breast cancer develops after augmentation mammoplasty.
尽管乳腺癌女性的保乳治疗（肿瘤切除、腋窝淋巴结清扫及术后放疗）生存率和局部复发率与改良根治性乳房切除术相当，但研究表明，术后放疗会导致乳房植入物患者出现包膜挛缩和美容效果不佳。
作者对20例隆乳术后发生乳腺癌的女性进行了随访（14例为皮下植入物，6例为胸大肌后植入物）。诊断时的平均年龄为52岁（范围34 - 72岁）。大多数（55%）患者的肿瘤位于外上象限。15个病灶可触及，5个不可触及。所有肿瘤均采用切缘较宽的方式切除，试图包括一圈正常乳腺组织。3例患者切缘显微镜检查呈阳性。主要组织学类型为导管腺癌（85%）。肿瘤最大径的平均值为1.43 cm；75%为T1期病变。Ⅰ级和Ⅱ级腋窝淋巴结清扫显示5例患者有转移。术后，6例患者接受了全身化疗，所有患者均接受了4500 - 5000 cGy的全乳切线光子放疗，外加1400 - 2100 cGy的肿瘤部位光子放疗、电子放疗或铱192植入瘤床补量放疗。
中位随访3.8年（范围6个月至9.3年），无局部复发；然而，2例患者发生远处转移。根据包膜挛缩程度、乳房形状和外观以及皮肤变化情况，20例患者中有17例（85%）美容效果良好或极佳。
作者得出结论，对于隆乳术后发生乳腺癌的女性，保乳治疗是一种美容效果可接受的治疗选择。
