Oncoplastic breast surgery: comprehensive review.
Oncoplastic breast surgery: comprehensive review.
复制标题
肿瘤整形乳房手术：综合回顾。
DOI：
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发表时间：
2017
影响因子：
3.3
通讯作者：
E. Raposio
中科院分区：
文献类型：
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作者：
N. Bertozzi;M. Pesce;P. Santi;E. Raposio
乳腺癌是西方人群中最常见的女性癌症，影响12.5%的女性，每年有138万患者。一旦保乳手术的总体和无病生存率被证明与乳房切除术相当，保乳手术后的术后放疗取代了Halsted和Patey的根治性和改良根治性手术，成为早期乳腺癌的标准治疗。然而，切除>20%的乳腺组织、低位或中心位置的癌症以及具有不同程度乳房下垂的大尺寸乳房，导致不可接受的美容结果。乳腺癌整形手术是从保乳手术发展而来的，它扩大了一般适应症，以实现更宽的切除边缘，而不影响美容效果。因此，乳房肿瘤整形手术可以被定义为一种肿瘤特异性的即时乳房再造方法，该方法将美学上衍生的乳房缩小技术应用于乳腺癌手术领域，并允许在不影响美学的情况下进行更大体积的切除。然而，对侧乳房对称化应被视为肿瘤整形手术的内在组成部分。所涉及的主要程序是体积置换或体积置换技术，这取决于乳房大小和癌症大小/位置。体积置换或整形手术应用整形外科原理将乳房组织的真皮腺体瓣转移到缺损部位，而体积置换技术使用自体组织来替代肿瘤切除后的体积损失。此外，这些手术比保乳手术更复杂和耗时。作者根据现有文献，分析了乳房肿瘤整形手术的不同技术和适应症，确定其并发症发生率，以帮助外科医生和患者在乳房重建的决策阶段。
Breast cancer is the most common female cancer in Western populations, affecting 12.5% of women, with 1.38 million patients per year. Breast-conserving surgery followed by postoperative radiotherapy replaced the radical and modified-radical procedures of Halsted and Patey as the standard of care for early-stage breast cancer once the overall and disease-free survival rates of breast-conserving surgery were demonstrated to be equivalent to those of mastectomy. However, excision of >20% of breast tissue, low or centrally located cancer, and large-sized breasts with various grades of breast ptosis, result a in unacceptable cosmetic outcomes. Oncoplastic breast surgery evolved from the breast-conserving surgery by broadening its general indication to achieve wider excision margins without compromising on the cosmetic outcomes. Thus, oncoplastic breast surgery can be defined as a tumor-specific immediate breast reconstruction method that applies aesthetically derived breast reduction techniques to the field of breast cancer surgery and allows for higher volume excision with no aesthetic compromise. However, contralateral breast symmetrization should be regarded as an intrinsic component of the oncoplastic surgery. The main procedures involved are volume-displacement or volume-replacement techniques, which depend on breast size and cancer size/location. Volume-displacement or reshaping procedures apply the plastic surgery principles to transpose a dermo-glandular flap of breast tissue into the defect site, while volume-replacement techniques use autologous tissues to replace the volume loss that follows tumor resection. Furthermore, these procedures are more complex and time-consuming than those involved in breast-conserving surgery. Based on current literature, the authors analyze the different techniques and indications of the oncoplastic breast surgery, determining its complication rate, in order to help both surgeons and their patients in the decision-making stage of breast reconstruction.