Garusi C, Petit J Y, Rietjens M, Lanfrey E
European Institute of Oncology, Milan, Italie.
Ann Chir Plast Esthet. 1997 Apr;42(2):168-76.
Conservative surgery (CS) is widely accepted today as the treatment of choice for 60 to 80% of the primary breast cancer. Esthetic results of CS are not good in all the cases and improvement can be obtained thanks to the remodelling of the breast after tumorectomy. The scar should be selected according to the location of the tumor; the glandular tissue should be reshaped using local glandular flaps or following the principles of the reduction mammaplasties. Tumorectomy located in the upper part of the gland can be reshaped with an inferior pedicle type of mammoplasty. Defect located in the inferior part of the gland can be reconstructed with a superior pedicle mammoplasty. These sophisticated tumorectomies are providing good esthetic results on the reconstructed breast but require commonly a symmetry procedure on the contralateral breast. Such contralateral reduction allows a better exploration of the opposite breast and histological examination of the reduction specimen. In a series of 76 CS performed at the European Institute of Oncology (IEO), which were associated with some kind of plastic procedure to lower the risk of bad cosmetic results (representing 25% of the CS associated with plastic surgery), we confirmed the value of the mixed oncologic and plastic approach. The esthetic results observed in this series are better than those observed in another series previously published at the Gustave-Roussy Institute (IGR)--good results: 72% (IEO) vs 50% (IGR), and bad results: 6% (IEO) vs 20% (IGR). Statistically such comparison can be criticised, specially because of the short follow-up of the Milan series. However, the difference is rather important if we consider that the series of Milan was a selection of cases with poor esthetic expectation (25% of all the CS performed during the same period), while the series of Paris did not select the patients in what concerns the risk of poor esthetic result.
如今，保守手术（CS）已被广泛接受为60%至80%原发性乳腺癌的首选治疗方法。CS的美学效果并非在所有情况下都良好，通过肿瘤切除术后乳房重塑可获得改善。应根据肿瘤位置选择切口；可使用局部腺体瓣或遵循缩乳术原则重塑腺体组织。位于腺体上部的肿瘤切除可采用下蒂型乳房成形术进行重塑。位于腺体下部的缺损可采用上蒂乳房成形术进行修复。这些复杂的肿瘤切除术在重建乳房上提供了良好的美学效果，但通常需要对侧乳房进行对称手术。这种对侧缩乳术有助于更好地探查对侧乳房并对缩乳标本进行组织学检查。在欧洲肿瘤研究所（IEO）进行的76例CS手术中，这些手术都联合了某种整形手术以降低不良美容效果的风险（占与整形手术相关的CS手术的25%），我们证实了肿瘤学与整形相结合方法的价值。该系列观察到的美学效果优于之前在古斯塔夫 - 鲁西研究所（IGR）发表的另一系列——良好效果：72%（IEO）对50%（IGR），不良效果：6%（IEO）对20%（IGR）。从统计学角度看，这种比较可能存在争议，特别是因为米兰系列的随访时间较短。然而，如果我们考虑到米兰系列是对美学期望较差的病例的选择（占同期所有CS手术的25%），而巴黎系列在美学效果不佳风险方面未对患者进行筛选，那么这种差异就相当显著了。
