中国乳房重建现状：单机构951例乳房重建经验

　　2016年6月，转化医学学会（STM）官方期刊、丁香园AME出版社旗下《腺体外科》杂志第5卷第3期正式发表复旦大学附属肿瘤医院乳腺外科、复旦大学上海医学院肿瘤学系、肿瘤医学协同创新中心的队列研究报告，回顾了2000年8月至2015年7月在复旦大学附属肿瘤医院乳腺外科接受乳房重建的所有患者，分析了患者的基线特征、重建方式、最终病理、局部区域复发情况。

　　结果发现，过去15年共有951例乳房重建，其中247例（27.0%）为腹部皮瓣重建，471例（51.5%）为背阔肌皮瓣±植入，233例（25.5%）为假体重建。大多数病例（78.1%）为浸润性乳腺癌，高达894例（94.0%）为立即重建。近年来假体重建迅速增加，伴双侧重建、对侧隆胸、较多并发症。中位随访时间26.6个月（范围：3.7～62.0个月）出现18例（2.0%）局部区域复发。共开展保留乳头乳晕复合体的乳房切除术66例（6.9%），其中无一例出现复发。

　　因此，15年来乳房重建病例随着手术方式变化而增加。最引人注目的是，假体重建迅速获得流行，成为最常用方式。保留乳头乳晕复合体的乳房切除术仅用于高度选择性患者。在本队列中，乳房重建患者能够达到满意的局部区域控制。

Gland Surg. 2016 Jun;5(3):278-86.

Current status of breast reconstruction in China: an experience of 951 breast reconstructions from a single institute.

Huang NS, Quan CL, Ma LX, Si J, Chen JJ, Yang BL, Huang XY, Liu GY, Shen ZZ, Shao ZM, Wu J.

Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China; Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.

BACKGROUND: Since mastectomy remained the primary strategy for treating breast cancer in China, post-mastectomy reconstruction is of great importance in the Chinese population. The current study aimed to assess the current status of breast reconstruction in China.

METHODS: We reviewed all patients who received breast reconstruction from August 2000 to July 2015 in the Department of Breast Surgery in our institute. Patients' baseline characteristics, reconstruction strategy, final pathology and loco-regional recurrence (LRR) information were collected.

RESULTS: A total of 951 breast reconstructions were conducted during the past 15 years, among which 247 (27.0%) were abdominal flap reconstruction; 471 (51.5%) were latissimus dorsi myocutaneous ± implant; and 233 (25.5%) were prosthesis-based reconstruction. The majority of cases (78.1%) were invasive breast cancer and up to 894 cases (94.0%) were immediate reconstruction. Prosthesis-based reconstruction rapidly increased in recent years, and was associated with bilateral reconstruction, contralateral augmentation and higher complications. 18 patients (2.0%) developed local-regional recurrence at the median follow-up time of 26.6 months (range, 3.7-62.0 months). A total of 66 nipple-areolar complex-sparing mastectomies (NSMs) (6.9%) were performed, none of which developed recurrence.

CONCLUSIONS: Breast reconstruction cases increased over the 15 years with the change of paradigm. Most strikingly, prosthesis-based reconstruction rapidly gained its prevalence and became the most common strategy. NSM was only performed for highly selected patients. Patients with breast reconstruction were able to achieve satisfactory loco-regional control in our cohort.

KEYWORDS: Breast reconstruction; China; breast cancer; current status

PMID: 27294034

PMCID: PMC4884702

DOI: 10.21037/gs.2016.03.01