切换至 "中华医学电子期刊资源库"

中华乳腺病杂志(电子版) ›› 2012, Vol. 06 ›› Issue (01) : 16 -23. doi: 10.3877/cma. j. issn.1674-0807.2012.01.003

论著

双侧乳腺切除加假体植入一期乳房重建治疗青年早期乳腺癌患者
唐欣1, 张艳君2, 李捷2, 郑一琼2, 刘蕾3, 高影4, 李席如2,()   
  1. 1.100007 北京,北京市首都医科大学北京妇产医院乳腺外科
    2.100853 北京,解放军总医院普通外科乳腺病学组
    3.300060 天津,天津医科大学附属肿瘤医院乳腺三科
    4.300071 天津,天津市南开大学医学院
  • 收稿日期:2011-12-28 出版日期:2012-02-01
  • 通信作者: 李席如

Immediate breast reconstruction with prosthetic implants following bilateral nipple preserving subcutaneous mastectomy for young patients with early breast cancer

Xin TANG1, Yan-jun ZHANG1, Jie LI1, Yi-qiong ZHENG1, Lei LIU1, Ying GAO1, Xi-ru LI1,()   

  1. 1.Division of Breast Surgery, Department of General Surgery, General Hospital of Chinese People's Liberation Army, Beijing 100853, China
  • Received:2011-12-28 Published:2012-02-01
  • Corresponding author: Xi-ru LI
引用本文:

唐欣, 张艳君, 李捷, 郑一琼, 刘蕾, 高影, 李席如. 双侧乳腺切除加假体植入一期乳房重建治疗青年早期乳腺癌患者[J/OL]. 中华乳腺病杂志(电子版), 2012, 06(01): 16-23.

Xin TANG, Yan-jun ZHANG, Jie LI, Yi-qiong ZHENG, Lei LIU, Ying GAO, Xi-ru LI. Immediate breast reconstruction with prosthetic implants following bilateral nipple preserving subcutaneous mastectomy for young patients with early breast cancer[J/OL]. Chinese Journal of Breast Disease(Electronic Edition), 2012, 06(01): 16-23.

目的

探讨保留皮肤和乳头乳晕复合体的双侧乳腺切除及假体植入一期乳房重建在青年早期乳腺癌治疗中的临床应用。

方法

回顾性分析2006年1月至2011年3月接受保留皮肤及乳头乳晕复合体双侧乳腺切除加假体植入一期乳房重建术的21 例青年早期乳腺癌患者临床资料。

结果

21 例患者手术成功,术后美容效果优良。随访12 ~72 个月(中位随访期为34 个月),无局部复发和远处转移。

结论

对青年早期乳腺癌患者,在切除患乳同时预防性切除对侧乳房,即行保留皮肤和乳头乳晕复合体的双侧乳腺切除加一期假体植入重建乳房,美容效果好,临床疗效满意。

Objective

To evaluate the application of immediate breast reconstruction (IBR) with silicon prosthetic implants following bilateral nipple preserving subcutaneous mastectomy in treatment of young patients with early breast cancer.

Methods

We retrospectively analyzed the clinical data of 21 patients with breast cancer who underwent IBR with prosthetic implants following bilateral nipple preserving subcutaneous mastectomy from January 2006 to March 2011.

Results

The operations were successful and excellent cosmetic results were obtained in all cases. No local recurrence or remote metastasis was found during the follow-up of 12-72 months (median 34 months).

Conclusion

For the young patients with breast cancer, the mastectomy on the affected side together with prophylactic excision of the contralateral side, i. e. IBR with prosthetic implants following bilateral nipple preserving subcutaneous mastectomy can obtain satisfactory cosmetic and clinical results.

表1 21 例患者的临床特征
图1 手术切口设计
图2 前哨淋巴结活检 沿腋窝延伸切口后,行前哨淋巴结活检。
图3 切除的腺体组织
图4 切除腺体后切口外观
图5 植入胸大肌后的扩张器
图6 保留乳头乳晕的腺体切除加一期假体植入乳房重建手术前后比较 a:手术前;b:手术后
[1]
Livi L, Meattini I, Saieva C, et al. The impact of young age on breast cancer outcome [J]. Eur J Surg Oncol,2010,36(7):639-645.
[2]
Beadle BM, Woodward WA, Buchholz TA. The impact of age on outcome in early-stage breast cancer [J]. Semin Radiat Oncol,2011,21(1):26-34.
[3]
Anders CK, Johnson R, Litton J, et al. Breast cancer before age 40 years[J]. Semin Oncol,2009,36(3):237-249.
[4]
Han W, Kang SY. Relationship between age at diagnosis and outcome of premenopausal breast cancer: age less than 35 years is a reasonable cut-off for defining young age-onset breast cancer[J]. Breast Cancer Res Treat,2010,119(1):193-200.
[5]
American College of Radiology.Practice guideline for the breast conservation therapy in the management of invasive breast carcinoma[J].J Am Coll Surg,2007,205(2):362-376.
[6]
Blichert-Toft M, Nielsen M, During M, et al. Long-term results of breast conserving surgery vs. mastectomy for early stage invasive breast cancer: 20-year follow-up of the Danish randomized DBCG-82TM protocol[J]. Acta Oncol,2008,47(4):672-681.
[7]
Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy,lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer[J]. N Engl J Med,2002,347(16):1233-1241.
[8]
van Dongen JA, Voogd AC, Fentiman IS, et al. Long-term results of a randomized trial comparing breast-conserving therapy with mastectomy: European Organization for Research and Treatment of Cancer 10801 trial[J]. J Natl Cancer Inst,2000,92(14):1143-1150.
[9]
Jacobs L. Positive margins: the challenge continues for breast surgeons[J]. Ann Surg Oncol,2008,15(5):1271-1272.
[10]
Asgeirsson KS, Rasheed T, McCulley SJ, et al. Oncological and cosmetic outcomes of oncoplastic breast conserving surgery[J]. EJSO,2005,31(8):817-823.
[11]
Bollet MA, Sigal-Zafrani B, Mazeau V, et al. Age remains the first prognostic factor for loco-regional breast cancer recurrence in young (<40 years) women treated with breast conserving surgery first [J].Radiother Oncol,2007,83(2):272-280.
[12]
de Bock GH, van der Hage JA, Putter H, et al. Isolated loco-regional recurrence of breast cancer is more common in young patients and following breast conserving therapy: long-term results of European Organisation for Research and Treatment of Cancer studies[J].Eur J Cancer,2006,42(3):351-356.
[13]
Tuttle TM, Habermann EB, Grund EH, et al. Increasing use of contralateral prophylactic mastectomy for breast cancer patients: a trend toward more aggressive surgical treatment[J]. J Clin Oncol,2007,25(33):5203-5209.
[14]
Adami HO, Bergström R, Hansen J. Age at first primary as a determinant of the incidence of bilateral breast cancer.Cumulative and relative risks in a population-based case-control study[J]. Cancer,1985,55(3):643-647.
[15]
Verhoog LC,Brekelmans CTM, Seynaeve C, et al. Contralateral breast cancer risk is influenced by the age at onset in BRCA1-associated breast cancer[J]. British J Cancer,2000,83(3):384-386.
[16]
Wood WC. Should the use of contralateral prophylactic mastectomy be increasing as it is? [J]. Breast,2009,18(S3):S93-S95.
[17]
de la Pea-Salcedo JA, Soto-Miranda MA, Lopez-Salguero JF. Prophylactic mastectomy: is it worth it? [J]. Aesthetic Plast Surg,2011,DOI:10.1007/s00266-011-9769-x.
[18]
Stucky CC, Gray RJ, Wasif N, et al. Increase in contralateral prophylactic mastectomy: echoes of a bygone era? surgical trends for unilateral breast cancer[J]. Ann Surg Oncol,2010,17(S3):S330-S337.
[19]
Rebbeck TR, Friebel T, Lynch HT,et al. Bilateral prophylactic mastectomy reduces breast cancer risk in BRCA1 and BRCA2 mutation carriers: the PROSE study group[J]. J Clin Oncol,2004,22(6):1055-1062.
[20]
Schrag D, Kuntz KM, Garber JE, et al. Life expectancy gains from cancer prevention strategies for women with breast cancer and BRCA1 or BRCA2 mutations[J]. JAMA,2000,283(5):617-624.
[21]
Spear SL, Schwarz KA, Venturi ML, et al. Prophylactic mastectomy and reconstruction: clinical outcomes and patient satisfaction[J]. Plast Reconstructr Surg,2008,122(1):1-9.
[1] 李洋, 蔡金玉, 党晓智, 常婉英, 巨艳, 高毅, 宋宏萍. 基于深度学习的乳腺超声应变弹性图像生成模型的应用研究[J/OL]. 中华医学超声杂志(电子版), 2024, 21(06): 563-570.
[2] 周荷妹, 金杰, 叶建东, 夏之一, 王进进, 丁宁. 罕见成人肋骨郎格汉斯细胞组织细胞增生症被误诊为乳腺癌术后骨转移一例[J/OL]. 中华乳腺病杂志(电子版), 2024, 18(06): 380-383.
[3] 河北省抗癌协会乳腺癌专业委员会护理协作组. 乳腺癌中心静脉通路护理管理专家共识[J/OL]. 中华乳腺病杂志(电子版), 2024, 18(06): 321-329.
[4] 刘晨鹭, 刘洁, 张帆, 严彩英, 陈倩, 陈双庆. 增强MRI 影像组学特征生境分析在预测乳腺癌HER-2 表达状态中的应用[J/OL]. 中华乳腺病杂志(电子版), 2024, 18(06): 339-345.
[5] 张晓宇, 殷雨来, 张银旭. 阿帕替尼联合新辅助化疗对三阴性乳腺癌的疗效及预后分析[J/OL]. 中华乳腺病杂志(电子版), 2024, 18(06): 346-352.
[6] 邱琳, 刘锦辉, 组木热提·吐尔洪, 马悦心, 冷晓玲. 超声影像组学对致密型乳腺背景中非肿块型乳腺癌的诊断价值[J/OL]. 中华乳腺病杂志(电子版), 2024, 18(06): 353-360.
[7] 程燕妮, 樊菁, 肖瑶, 舒瑞, 明昊, 党晓智, 宋宏萍. 乳腺组织定位标记夹的应用与进展[J/OL]. 中华乳腺病杂志(电子版), 2024, 18(06): 361-365.
[8] 涂盛楠, 胡芬, 张娟, 蔡海峰, 杨俊泉. 天然植物提取物在乳腺癌治疗中的应用[J/OL]. 中华乳腺病杂志(电子版), 2024, 18(06): 366-370.
[9] 朱文婷, 顾鹏, 孙星. 非酒精性脂肪性肝病对乳腺癌发生发展及治疗的影响[J/OL]. 中华乳腺病杂志(电子版), 2024, 18(06): 371-375.
[10] 葛睿, 陈飞, 李杰, 李娟娟, 陈涵. 多基因检测在早期乳腺癌辅助治疗中的应用价值[J/OL]. 中华乳腺病杂志(电子版), 2024, 18(05): 257-263.
[11] 高杰红, 黎平平, 齐婧, 代引海. ETFA和CD34在乳腺癌中的表达及与临床病理参数和预后的关系研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 64-67.
[12] 韩萌萌, 冯雪园, 马宁. 乳腺癌改良根治术后桡神经损伤1例[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 117-118.
[13] 张志兆, 王睿, 郜苹苹, 王成方, 王成, 齐晓伟. DNMT3B与乳腺癌预后的关系及其生物学机制[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 624-629.
[14] 王玲艳, 高春晖, 冯雪园, 崔鑫淼, 刘欢, 赵文明, 张金库. 循环肿瘤细胞在乳腺癌新辅助及术后辅助治疗中的应用[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 630-633.
[15] 赵林娟, 吕婕, 王文胜, 马德茂, 侯涛. 超声引导下染色剂标记切缘的梭柱型和圆柱型保乳区段切除术的效果研究[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 634-637.
阅读次数
全文


摘要