• 四川大學(xué)華西醫(yī)院甲狀腺乳腺外科（四川成都 610041）;

目的 　探討乳房切除術(shù)后放射治療（簡稱放療）與各種乳房重建方式的相互影響關(guān)系以及如何選擇重建方式和時機。
方法 　檢索近年來有關(guān)放療與乳房重建的文獻(xiàn)并做綜述。
結(jié)果 　放療可能增加乳房重建（自體組織重建或組織擴張器/假體重建）并發(fā)癥的發(fā)生，影響其美容效果；重建乳房亦可能會影響放療的療效。
結(jié)論 　對于那些乳房切除術(shù)后明確需要放療或已經(jīng)接受放療的患者，選擇自體組織二期乳房重建；對于乳房切除術(shù)同時尚不能確定是否需要進(jìn)行放療的患者，選擇延遲的即刻重建，或在患者清楚并接受放療可能帶來更高的并發(fā)癥和美容效果受影響的前提下選擇即刻自體組織重建。

引用本文： 羊曉勤,王榮,呂青,李宏江. 放射治療與乳腺癌術(shù)后乳房重建的現(xiàn)狀. 中國普外基礎(chǔ)與臨床雜志, 2013, 20(8): 867-871. doi: 復(fù)制

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3. Taylor ME， Haffty BG， Rabinovitch R， et al. ACR appropriateness criteria on postmastectomy radiotherapy expert panel on radiation oncology-breast[J]. Int J Radiat Oncol Biol Phys， 2009， 73(4)：997-1002.
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5. Schneider WJ， Hill HL Jr， Brown RG. Latissimus dorsi myocutaneous flap for breast reconstruction[J]. Br J Plast Surg， 1977， 30(4)：277-281.
6. Losken A， Jurkiewicz MJ. History of breast reconstruction[J]. Breast Dis， 2002， 16(16)：3-9.
7. Cronin TD， Gerow FJ. Augmentation mammaplasty：A new “natural feel” prothesis//Broadbent TRR ed. Transactions of the third international congress of plastic surgery[M]. October 13-18， 1963， Washingtonn D. C， Amsterdam：Excerpta Medica， 1964：41-49.
8. Radovan C. Breast reconstruction after mastectomy using the temporary expander J]. Plast Reconstr Surg， 1982， 69(2)：195-208.
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12. Spear SL， Onyewu C. Staged breast reconstruction with saline-filled implants in the irradiated breast：recent trends and therapeuticimplications[J]. Plast Reconstr Surg， 2000， 105(3)：930-942.
13. Ascherman JA， Hanasono MM， Newman MI， et al. Implant reconstruction in breast cancer patients treated with radiation therapy[J]. Plast Reconstr Surg， 2006， 117(2)：359-365.
14. Baschnagel AM， Shah C， Wilkinson JB， et al. Failure rate and cosmesis of immediate tissue expander/implant breast reconstruction after postmastectomy irradiation[J]. Clin Breast Cancer， 2012， 12(6)：428-432.
15. Ho A， Cordeiro P， Disa J， et al. Long-term outcomes in breast cancer patients undergoing immediate 2-stage expander/implant reconstruction and postmastectomy radiation[J]. Cancer， 2012， 118(9)：2552-2559.
16. Tallet AV， Salem N， Moutardier V， et al. Radiotherapy and imme-diate two-stage breast reconstruction with a tissue expander and implant：complications and esthetic results[J]. Int J Radiat OncolBiol Phys， 2003， 57(1)：136-142.
17. Benediktsson K， Perbeck L. Capsular contracture around saline-filled and textured subcutaneously-placed implants in irradiated and non-irradiated breast cancer patients：five years of monitoring of a prospective trial[J]. J Plast Reconstr Aesthet Surg， 2006， 59(1)：27-34.
18. Kronowitz SJ. Current status of implant-based breast reconstruction in patients receiving postmastectomy radiation therapy[J]. Plast Reconstr Surg， 2012， 130(4)：513e-524e.
19. Spear SL， Mardini S， Ganz JC. Resource cost comparison ofimplant-based breast reconstruction versus TRAM flap breast recons-truction[J]. Plast Reconstr Surg， 2003， 112(1)：101-105.
20. Blondeel N， Vanderstraeten GG， Monstrey SJ， et al. The donor site morbidity of free DIEP flaps and free TRAM flaps for breast reconstruction[J]. Br J Plast Surg， 1997， 50(5)：322-330.
21. Williams JK， Carlson GW， Bostwick J 3rd， et al. The effects of radiation treatment after TRAM flap breast reconstruction[J]. Plast Reconstr Surg， 1997， 100(5)：1153-1160.
22. Tran NV， Chang DW， Gupta A， et al. Comparison of immediateand delayed free TRAM flap breast reconstruction in patients receiving postmastectomy radiation therapy[J]. Plast Reconstr Surg， 2001， 108(1)：78-82.
23. Rogers NE， Allen RJ. Radiation effects on breast reconstruction with the deep inferior epigastric perforator flap[J]. Plast ReconstrSurg， 2002， 109(6)：1919-1924.
24. Shah C， Kundu N， Arthur D， et al. Radiation therapy following postmastectomy reconstruction：a systematic review[J]. Ann Surg Oncol， 2013， 20(4)：1313-1322.
25. Durkan B， Amersi F， Phillips EH， et al. Postmastectomy radiation of latissimus dorsi myocutaneous flap reconstruction is well tolerated in women with breast cancer[J]. Am Surg， 2012， 78(10)：1122-1127.
26. Barry M， Kell MR. Radiotherapy and breast reconstruction：a meta-analysis[J]. Breast Cancer Res Treat， 2011， 127(1)：15-22.
27. Carlson GW， Page AL， Peters K， et al. Effects of radiation therapyon pedicled transverse rectus abdominis myocutaneous flap breast reconstruction[J]. Ann Plast Surg， 2008， 60(5)：568-572.
28. Spear SL， Ducic I， Low M， et al. The effect of radiation on pedicled TRAM flap breast reconstruction：outcomes and implications[J]. Plast Reconstr Surg， 2005， 115(1)：84-95.
29. Makmur L， Lim J， Lim TC. Radiation therapy in immediate breast reconstruction with DIEP flap[J]. Plast Reconstr Surg， 2003， 112(3)：920-921.
30. Momoh AO， Colakoglu S， de Blacam C， et al. Delayed autologous breast reconstruction after postmastectomy radiation therapy：is there an optimal time?[J]. Ann Plast Surg， 2012， 69(1)：14-18.
31. Evans GR， Schusterman MA， Kroll SS， et al. Reconstruction and the radiated breast：is there a role for implants?[J]. Plast Reconstr Surg， 1995， 96(5)：1111-1115.
32. Christante D， Pommier SJ， Diggs BS， et al. Using complications associated with postmastectomy radiation and immediate breast reconstruction to improve surgical decision making[J]. Arch Surg， 2010， 145(9)：873-878.
33. Kronowitz SJ， Chang DW， Robb GL， et al. Implications of axillarysentinel lymph node biopsy in immediate autologous breast reconstruction[J]. Plast Reconstr Surg， 2002， 109(6)：1888-1896.
34. Kronowitz SJ， Hunt KK， Kuerer HM， et al. Delayed-immediate breast reconstruction[J]. Plast Reconstr Surg， 2004， 113(6)：1617-1628.
35. Kronowitz SJ. Delayed-immediate breast reconstruction：technicaland timing considerations[J]. Plast Reconstr Surg， 2010， 125(2)：463-474.
36. Kronowitz SJ， Kuerer HM. Advances and surgical decision-making for breast reconstruction[J]. Cancer， 2006， 107(5)：893-907.
37. Motwani SB， Strom EA， Schechter NR， et al. The impact of immediate breast reconstruction on the technical delivery of postmastectomy radiotherapy[J]. Int J Radiat Oncol Biol Phys， 2006， 66(1)：76-82.
38. Chung E， Marsh RB， Griffith KA， et al. Quantifying dose to the reconstructed breast：can we adequately treat?[J]. Med Dosim， 2013， 38(1)：55-59.
39. Ohri N， Cordeiro PG， Keam J， et al. Quantifying the impact of immediate reconstruction in postmastectomy radiation：a large， dose-volume histogram-based analysis[J]. Int J Radiat Oncol Biol Phys， 2012， 84(2)：e153-e159.
  1. 1. Sieber DA， Vandevender DK， Albuquerque KV. Intermeshing breast reconstruction and postmastectomy radiation[J]. Expert Rev Anticancer Ther， 2010， 10(8)：1273-1283.
  2. 2. Rehman MU， Buttar QM， Khawaja MI， et al. An impending cancer crisis in developing countries：are we ready for the cha-llenge?[J]. Asian Pac J Cancer Prev， 2009， 10(4)：719-720.
  3. 3. Taylor ME， Haffty BG， Rabinovitch R， et al. ACR appropriateness criteria on postmastectomy radiotherapy expert panel on radiation oncology-breast[J]. Int J Radiat Oncol Biol Phys， 2009， 73(4)：997-1002.
  4. 4. Ragaz J， Olivotto IA， Spinelli JJ， et al. Locoregional radiation therapy in patients with high-risk breast cancer receiving adjuvant chemotherapy：20-year results of the British Columbia randomized trial[J]. J Natl Cancer Inst， 2005， 97(2)：116-126.
  5. 5. Schneider WJ， Hill HL Jr， Brown RG. Latissimus dorsi myocutaneous flap for breast reconstruction[J]. Br J Plast Surg， 1977， 30(4)：277-281.
  6. 6. Losken A， Jurkiewicz MJ. History of breast reconstruction[J]. Breast Dis， 2002， 16(16)：3-9.
  7. 7. Cronin TD， Gerow FJ. Augmentation mammaplasty：A new “natural feel” prothesis//Broadbent TRR ed. Transactions of the third international congress of plastic surgery[M]. October 13-18， 1963， Washingtonn D. C， Amsterdam：Excerpta Medica， 1964：41-49.
  8. 8. Radovan C. Breast reconstruction after mastectomy using the temporary expander J]. Plast Reconstr Surg， 1982， 69(2)：195-208.
  9. 9. Becker H. Breast reconstruction using an inflatable breast implant with detachable reservoir J]. Plast Reconstr Surg， 1984， 73(4)：678-683.
  10. 10. Cordeiro PG， Mccarthy CM. A single surgeon’s 12-year experiencewith tissue expander/implant breast reconstruction：partⅠ. A pros-pective analysis of early complications[J]. Plast Reconstr Surg， 2006， 118(4)：825-831.
  11. 11. Cordeiro PG， McCarthy CM. A single surgeon’s 12-year experience with tissue expander/implant breast reconstruction：part Ⅱ. An analysis of long-term complications， aesthetic outcomes， and patient satisfaction[J]. Plast Reconstr Surg， 2006， 118(4)：832-839.
  12. 12. Spear SL， Onyewu C. Staged breast reconstruction with saline-filled implants in the irradiated breast：recent trends and therapeuticimplications[J]. Plast Reconstr Surg， 2000， 105(3)：930-942.
  13. 13. Ascherman JA， Hanasono MM， Newman MI， et al. Implant reconstruction in breast cancer patients treated with radiation therapy[J]. Plast Reconstr Surg， 2006， 117(2)：359-365.
  14. 14. Baschnagel AM， Shah C， Wilkinson JB， et al. Failure rate and cosmesis of immediate tissue expander/implant breast reconstruction after postmastectomy irradiation[J]. Clin Breast Cancer， 2012， 12(6)：428-432.
  15. 15. Ho A， Cordeiro P， Disa J， et al. Long-term outcomes in breast cancer patients undergoing immediate 2-stage expander/implant reconstruction and postmastectomy radiation[J]. Cancer， 2012， 118(9)：2552-2559.
  16. 16. Tallet AV， Salem N， Moutardier V， et al. Radiotherapy and imme-diate two-stage breast reconstruction with a tissue expander and implant：complications and esthetic results[J]. Int J Radiat OncolBiol Phys， 2003， 57(1)：136-142.
  17. 17. Benediktsson K， Perbeck L. Capsular contracture around saline-filled and textured subcutaneously-placed implants in irradiated and non-irradiated breast cancer patients：five years of monitoring of a prospective trial[J]. J Plast Reconstr Aesthet Surg， 2006， 59(1)：27-34.
  18. 18. Kronowitz SJ. Current status of implant-based breast reconstruction in patients receiving postmastectomy radiation therapy[J]. Plast Reconstr Surg， 2012， 130(4)：513e-524e.
  19. 19. Spear SL， Mardini S， Ganz JC. Resource cost comparison ofimplant-based breast reconstruction versus TRAM flap breast recons-truction[J]. Plast Reconstr Surg， 2003， 112(1)：101-105.
  20. 20. Blondeel N， Vanderstraeten GG， Monstrey SJ， et al. The donor site morbidity of free DIEP flaps and free TRAM flaps for breast reconstruction[J]. Br J Plast Surg， 1997， 50(5)：322-330.
  21. 21. Williams JK， Carlson GW， Bostwick J 3rd， et al. The effects of radiation treatment after TRAM flap breast reconstruction[J]. Plast Reconstr Surg， 1997， 100(5)：1153-1160.
  22. 22. Tran NV， Chang DW， Gupta A， et al. Comparison of immediateand delayed free TRAM flap breast reconstruction in patients receiving postmastectomy radiation therapy[J]. Plast Reconstr Surg， 2001， 108(1)：78-82.
  23. 23. Rogers NE， Allen RJ. Radiation effects on breast reconstruction with the deep inferior epigastric perforator flap[J]. Plast ReconstrSurg， 2002， 109(6)：1919-1924.
  24. 24. Shah C， Kundu N， Arthur D， et al. Radiation therapy following postmastectomy reconstruction：a systematic review[J]. Ann Surg Oncol， 2013， 20(4)：1313-1322.
  25. 25. Durkan B， Amersi F， Phillips EH， et al. Postmastectomy radiation of latissimus dorsi myocutaneous flap reconstruction is well tolerated in women with breast cancer[J]. Am Surg， 2012， 78(10)：1122-1127.
  26. 26. Barry M， Kell MR. Radiotherapy and breast reconstruction：a meta-analysis[J]. Breast Cancer Res Treat， 2011， 127(1)：15-22.
  27. 27. Carlson GW， Page AL， Peters K， et al. Effects of radiation therapyon pedicled transverse rectus abdominis myocutaneous flap breast reconstruction[J]. Ann Plast Surg， 2008， 60(5)：568-572.
  28. 28. Spear SL， Ducic I， Low M， et al. The effect of radiation on pedicled TRAM flap breast reconstruction：outcomes and implications[J]. Plast Reconstr Surg， 2005， 115(1)：84-95.
  29. 29. Makmur L， Lim J， Lim TC. Radiation therapy in immediate breast reconstruction with DIEP flap[J]. Plast Reconstr Surg， 2003， 112(3)：920-921.
  30. 30. Momoh AO， Colakoglu S， de Blacam C， et al. Delayed autologous breast reconstruction after postmastectomy radiation therapy：is there an optimal time?[J]. Ann Plast Surg， 2012， 69(1)：14-18.
  31. 31. Evans GR， Schusterman MA， Kroll SS， et al. Reconstruction and the radiated breast：is there a role for implants?[J]. Plast Reconstr Surg， 1995， 96(5)：1111-1115.
  32. 32. Christante D， Pommier SJ， Diggs BS， et al. Using complications associated with postmastectomy radiation and immediate breast reconstruction to improve surgical decision making[J]. Arch Surg， 2010， 145(9)：873-878.
  33. 33. Kronowitz SJ， Chang DW， Robb GL， et al. Implications of axillarysentinel lymph node biopsy in immediate autologous breast reconstruction[J]. Plast Reconstr Surg， 2002， 109(6)：1888-1896.
  34. 34. Kronowitz SJ， Hunt KK， Kuerer HM， et al. Delayed-immediate breast reconstruction[J]. Plast Reconstr Surg， 2004， 113(6)：1617-1628.
  35. 35. Kronowitz SJ. Delayed-immediate breast reconstruction：technicaland timing considerations[J]. Plast Reconstr Surg， 2010， 125(2)：463-474.
  36. 36. Kronowitz SJ， Kuerer HM. Advances and surgical decision-making for breast reconstruction[J]. Cancer， 2006， 107(5)：893-907.
  37. 37. Motwani SB， Strom EA， Schechter NR， et al. The impact of immediate breast reconstruction on the technical delivery of postmastectomy radiotherapy[J]. Int J Radiat Oncol Biol Phys， 2006， 66(1)：76-82.
  38. 38. Chung E， Marsh RB， Griffith KA， et al. Quantifying dose to the reconstructed breast：can we adequately treat?[J]. Med Dosim， 2013， 38(1)：55-59.
  39. 39. Ohri N， Cordeiro PG， Keam J， et al. Quantifying the impact of immediate reconstruction in postmastectomy radiation：a large， dose-volume histogram-based analysis[J]. Int J Radiat Oncol Biol Phys， 2012， 84(2)：e153-e159.