Handel N, Lewinsky B, Jensen J A, Silverstein M J
Plast Reconstr Surg. 1996 Dec;98(7):1216-24. doi: 10.1097/00006534-199612000-00015.
Breast conservation therapy, consisting of lumpectomy, axillary node dissection, whole-breast irradiation, and a boost to the tumor bed, is an increasingly popular option for the treatment of breast cancer. Among patients with stage I and stage II disease, breast conservation therapy yields survival rates equivalent to those for mastectomy. The cosmetic results of radiotherapy are usually good, and this approach preserves an intact, sensate breast. Most studies on breast conservation therapy, however, have been performed in nonaugmented patients. Relatively little has been published regarding breast conservation therapy in the presence of silicone implants. Between 1981 and 1994, we treated 33 augmented patients with breast conservation therapy. Among 26 individuals for whom complete follow-up data were available, 17 (65 percent) developed significant capsular contracture on the irradiated side. Thus far 8 patients with radiation-induced contracture have undergone corrective surgery. In our experience, augmented breast cancer patients treated with breast conservation therapy have less satisfactory cosmetic results than nonaugmented women. In addition, mammographic follow-up, critical for identifying local recurrence, may be impaired by the presence of an implant and capsular contracture. On the basis of these considerations, breast conservation therapy may be less than optimal in augmented cancer patients unless explantation is performed before treatment.
保乳治疗包括肿块切除术、腋窝淋巴结清扫术、全乳放疗以及对瘤床的追加放疗，是一种越来越受欢迎的乳腺癌治疗选择。在I期和II期疾病患者中，保乳治疗的生存率与乳房切除术相当。放疗的美容效果通常较好，且这种方法能保留完整、有感觉的乳房。然而，大多数关于保乳治疗的研究是在未隆乳的患者中进行的。关于硅胶植入物存在情况下的保乳治疗，相关报道相对较少。1981年至1994年间，我们对33例接受保乳治疗的隆乳患者进行了治疗。在有完整随访数据的26例患者中，17例（65%）在放疗侧出现了明显的包膜挛缩。到目前为止，8例因放疗导致挛缩的患者接受了矫正手术。根据我们的经验，接受保乳治疗的隆乳乳腺癌患者的美容效果不如未隆乳的女性。此外，对于识别局部复发至关重要的乳腺钼靶随访，可能会因植入物和包膜挛缩的存在而受到影响。基于这些考虑，除非在治疗前取出植入物，否则保乳治疗对于隆乳癌症患者可能并非最佳选择。
