乳房皱襞下带蒂脂肪瓣在下方象限乳腺癌保乳手术乳房修复中的应用

Application of Inframammary Adipofascial Flap in Immediate Reconstruction in Breast-conserving Surgery for Inferior Quadrant Breast Cancer

目的探讨乳房皱襞下带蒂脂肪瓣修复下方象限乳腺癌保乳手术乳房局部缺损的有效性和安全性。方法2017年1月~2018年12月,对7例肿瘤位于下方象限的乳腺癌行保乳手术,肿瘤最大径1.0~3.5 cm,平均1.9 cm,应用皱襞下带蒂脂肪瓣修复乳房缺损。术后均行静脉辅助化疗及全乳放疗,其中5例HER-2阳性者曲妥珠单抗靶向治疗1年,5例激素受体阳性者内分泌治疗。放疗后每3个月门诊复查,评估有无复发,采用Harvard/NSABP(National Surgical Adjuvant Breast and Bowel Project)/RTOG(Radiation Therapy Oncology Group)乳房美容评分量表评定乳房外形美容效果。结果7例转移脂肪瓣均成活,无术后并发症。中位随访39个月(30~40个月),均无肿瘤复发及转移。放疗对转移的脂肪瓣未见明显影响,乳房外形评价优4例,良3例。患者对乳房外观满意。结论乳房皱襞下带蒂脂肪瓣可以用于修复下方象限乳腺癌保乳手术所致的乳腺局部缺损。

Objective To evaluate the cosmetic outcomes and the safety of application of inframammary adipofascial flap to reconstruct inferior quadrant defect in breast-conserving surgery.Methods From January 2017 to December 2018,7 patients with breast cancer located in the lower region of the breast in our hospital were recruited.All the patients were treated by using inframammary adipofascial flap to reconstruct defect immediately after breast-conserving procedures.The mean tumor size was 1.9 cm(range,1.0-3.5 cm).All the patients received whole breast radiotherapy and adjuvant chemotherapy.Five patients with HER-2 positive received targeted therapy with trastuzumab for one year and 5 patients with estrogen receptor positive underwent adjuvant endocrine therapy.All the patients were followed up once every 3 month after the completion of radiotherapy.The tumor recurrence was assessed,and the cosmetic outcomes were assessed by using the Harvard/NSABP/RTOG Breast Cosmesis Grading Scale.ResultsAll the inframammary adipofascial flaps survived without necrosis.After a median follow-up period of 39 months(range,30-40 months),all the patients survived disease-free.There was no significant effect on inframammary adipofascial flap after the whole breast radiotherapy.Cosmetic outcomes were excellent in 4 and good in 3 patients,respectively.All the patients had a good subjective satisfaction.Conclusion The inframammary adipofascial flap can be used to repair inferior quadrant defect of breast after breast conserving surgery,with good cosmetic outcomes.