Dauplat J, Le Bouedec G, Janny-Peyronie M, Vergote T, Kauffmann P, Feillel V
Service de Chirurgie, Unité de Chirurgie Oncologique, Clermont-Ferrand.
J Gynecol Obstet Biol Reprod (Paris). 1996;25(1):17-26.
A series of 112 mastectomies with immediate breast reconstruction performed in women with invasive cancer of the breast were followed for a mean of 30 months to determine cancer outcome, morbidity and aesthetic results of the different surgical techniques. The patients were divided into 3 groups according to indications: 49 cases with local recurrence after conservative treatment; 37 cases of large or multifocal tumours operated after chemotherapy and radiotherapy; 26 cases after tentative conservative surgery with incomplete tumourectomy. A total of 98 patients (87.5%) were irradiated before mastectomy with immediate breast reconstruction. Twenty-eight simple implants, 50 musculocutaneous flaps using the latissimus dorsi with implant and 34 musculocutaneous flaps with the rectus abdominis. During follow-up 16 patients died and cancer relapsed in 13 surviving patients. Seven local recurrences were observed. In all cases of early relapse, which may have possibly been triggered by immediate breast reconstruction, the patients had very poor prognosis criteria. Surgery took longer for mastectomy with immediate breast reconstruction using the rectus abdominis flap and required transfusion in 88% of the cases. Combining all the techniques, 19% of the patients had postoperative complications and 25% late sequellae. The aesthetic results were considered as good immediately after surgery in 14% of the patients with a simple implant, in 45% of those with a latissimus dorsi flap and in 81% of those with a rectus abdominis flap. Second surgical procedures to improve the aspect were performed in half the patients with a simple implant giving 50% good results, in 40% of the patients with a latissimus dorsi flap giving 68% good results and in 12% of the patients with a rectus abdominis flap giving 84% good results. In this series, patient satisfaction was closely related to the aesthetic quality of the results. Integrated into a well-planned multidisciplinary protocol, mastectomy with immediate breast reconstruction does not appear to affect the cancer outcome. Immediate breast reconstruction is a complex procedure and requires experience in plastic surgery to reduce the number of complications and to improve aesthetic results. Reconstruction with a rectus abdominus flap appears as the superior technique.
对112例行即刻乳房重建的乳腺癌根治术女性患者进行了平均30个月的随访，以确定不同手术技术的癌症转归、发病率和美学效果。根据适应证将患者分为3组：49例为保乳治疗后局部复发；37例为经化疗和放疗后手术切除的大肿瘤或多灶性肿瘤；26例为试行保乳手术但肿瘤切除不完全。共有98例患者（87.5%）在即刻乳房重建的乳腺癌根治术前接受了放疗。28例采用单纯假体植入，50例采用背阔肌肌皮瓣联合假体植入，34例采用腹直肌肌皮瓣。随访期间，16例患者死亡，13例存活患者出现癌症复发。观察到7例局部复发。在所有可能由即刻乳房重建引发的早期复发病例中，患者的预后标准都很差。采用腹直肌肌皮瓣进行即刻乳房重建的乳腺癌根治术手术时间较长，88%的病例需要输血。综合所有技术，19%的患者有术后并发症，25%有晚期后遗症。术后即刻美学效果被认为良好的患者比例为：单纯假体植入患者中占14%，背阔肌肌皮瓣患者中占45%，腹直肌肌皮瓣患者中占81%。为改善外观而进行二次手术的患者比例为：单纯假体植入患者中有一半，其中50%效果良好；背阔肌肌皮瓣患者中有40%，其中68%效果良好；腹直肌肌皮瓣患者中有12%，其中84%效果良好。在本系列研究中，患者满意度与手术效果的美学质量密切相关。纳入精心规划的多学科方案后，即刻乳房重建的乳腺癌根治术似乎不影响癌症转归。即刻乳房重建是一项复杂的手术，需要整形外科经验以减少并发症数量并改善美学效果。腹直肌肌皮瓣重建似乎是更优的技术。
