• 首都醫(yī)科大學(xué)宣武醫(yī)院普外科（北京 100053）;

目的 　綜述乳腺癌保乳手術(shù)中乳房缺損的修復(fù)方法。
方法 　分析近年來相關(guān)文獻，對有關(guān)乳腺癌保乳手術(shù)中乳房缺損的修復(fù)方法、適應(yīng)證、切口選擇以及優(yōu)缺點進行分析。
結(jié)果 　保乳手術(shù)后部分患者存在乳房畸形，美容效果不佳。如何選擇手術(shù)切口、怎樣修復(fù)腫瘤切除后的乳房缺損，以獲得較好的美容效果是外科手術(shù)中的焦點問題。將乳房整形技術(shù)應(yīng)用于保乳手術(shù)，可明顯改善美容效果。
結(jié)論 　選擇合適的早期乳腺癌患者采用乳房整形技術(shù)進行保乳手術(shù)治療，安全、有效，術(shù)后患者對乳房外形及整體美容效果滿意度高，是值得推薦的一種技術(shù)。

引用本文： 朱江,康驊. 乳腺癌保乳手術(shù)中乳房缺損的修復(fù)方法. 中國普外基礎(chǔ)與臨床雜志, 2012, 19(7): 799-804. doi: 復(fù)制

1. Veronesi U， Salvadori B， Luini A， et al. Conservative treatment of early breast cancer：long-term results of 1 232 cases treated with quadrantectomy， axillary dissection， and radiotherapy [J].Ann Surg， 1990， 211(3)：250-259.
2. Yu KD， Di GH， Wu J， et al. Development and trends of surgical modalities for breast cancer in China： a review of 16-year data[ J].Ann Surg Oncol， 2007， 14(9)：2502-2509.
3. Veronesi U， Cascinelli N， Mariani L， et al. Twenty-year followup of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer [J]. N Engl J Med， 2002， 347(16)：1227-1232.
4. Chan SW， Cheung PS， Lam SH. Cosmetic outcome and percentage of breast volume excision in oncoplastic breast conserving surgery [J]. World J Surg， 2010， 34(7)：1447-1452.
5. Klassen AF， Pusic AL， Scott A， et al. Satisfaction and quality of life in women who undergo breast surgery：a qualitative study [J]. BMC Womens Health， 2009， 9：11-19.
6. Veiga DF， Veiga-Filho J， Ribeiro LM， et al. Quality-of-life and self-esteem outcomes after oncoplastic breast-conserving surgery [J]. Plast Reconstr Surg. 2010， 125(3)：811-817.
7. Tan M， Ung O. Alternative approaches for oncoplastic breast surgery [J]. Ann Surg Oncol， 2011， 18(1)：297-299.
8. 馬銀斌， 王彥銘， 李偉， 等. 乳暈切口及殘腔無縫合技術(shù)在乳腺良性腫塊切除術(shù)中的應(yīng)用 [J]. 中國美容醫(yī)學(xué)， 2010， 19(5)：3-4.
9. Veiga DF， Veiga-Filho J， Ribeiro LM， et al. Evaluations of aesthetic outcomes of oncoplastic surgery by surgeons of different gender and specialty：a prospective controlled study [J]. Breast，2011， 20(5)： 407-412.
10. Fitoussi AD， Berry MG， Famà F， et al. Oncoplastic breast surgery for cancer：analysis of 540 consecutive cases [outcomes article] [J]. Plast Reconstr Surg， 2010， 125(2)：454-462.
11. Chakravorty A， Shrestha AK， Sanmugalingam N， et al. How safe is oncoplastic breast conservation? Comparative analysiswith standard breast conserving surgery [J]. Eur J Surg Oncol，2012， 38(5)：395-398.
12. Yang JD， Lee JW， Kim WW， et al. Oncoplastic surgical techniques for personalized breast conserving surgery in breast cancer patient with small to moderate sized breast [J]. J Breast Cancer，2011， 14(4)：253-261.
13. Meretoja TJ， Svarvar C， Jahkola TA， et al. Outcome of oncoplastic breast surgery in 90 prospective patients [J]. Am J Surg，2010， 200(2)：224-228.
14. 康驊， 朱江， 海濤， 等. 乳房整形技術(shù)在乳腺癌保乳手術(shù)中的應(yīng)用體會 [J]. 中國普外基礎(chǔ)與臨床雜志， 2011， 18(9)：917-921.
15. Urban C， Lima R， Schunemann E， et al. Oncoplastic principles in breast conserving surgery [J]. Breast， 2011， 20 Suppl 3：S92-S95.
16. Gainer SM， Lucci A. Oncoplastics： techniques for reconstruction of partial breast defects based on tumor location [J]. J Surg Oncol，2011， 103(4)：341-347.
17. Clough KB， Soussaline M， Campana F， et al. Mammoplasty combined with irradiation：conservative treatment of breast cancer localized in the lower quadrant [J]. Ann Chir Plast Esthet， 1990，35(2)：117-122.
18. Lassus C. A 30-year experience with vertical mammaplasty [J].Plast Reconstr Surg， 1996， 97(2)：373-380.
19. Clough KB， Kaufman GJ， Nos C， et al. Improving breast cancer surgery：a classification and quadrant per quadrant atlas for oncoplastic surgery [J]. Ann Surg Oncol， 2010， 17(5)：1375-1391.
20. Benelli L. A New periareolar mammaplasty：the “round block”technique [J]. Aesthetic Plast Surg， 1990， 14(2)：93-100.
21. Robbins TH. A reduction mammaplasty with the areola-nipple based on an inferior dermal pedicle [J]. Plast Reconstr Surg，1977， 59(1)：64-67.
22. Anderson BO， Masetti R， Silverstein MJ. Oncoplastic approaches to partial mastectomy：an overview of volume-displacement techniques [J]. Lancet Oncol， 2005， 6(3)：145-157.
23. Pennisi VR. Making a definite inframammary fold under a reconstructed breast [J]. Plast Reconstr Surg， 1977， 60(4)：523-525.
24. Kijima Y， Yoshinaka H， Hirata M， et al. Immediate reconstruction using a modified thoracodorsal adipofascial cutaneous flap after partial mastectomy [J]. Breast， 2011， 20(5)：464-467.
25. Ogawa T， Hanamura N， Yamashita M， et al. Long-term results of breast volume replacement using an inframammary adipofascial flap after breast-conserving surgery [J]. Breast Cancer， 2011 Jun28. [ Epub ahead of print].
26. Kijima Y， Yoshinaka H， Owaki T， et al. Immediate reconstruction using inframammary adipofascial flap of the anterior rectus sheath after partial mastectomy [J]. Am J Surg， 2007， 193(6)：789-791.
27. Aljarrah A， Nos C， Nasr R， et al. Updated follow-up of patients treated with the oncoplastic “Crescent” technique for breast cancer [J]. Breast， 2011 Dec 18. [ Epub ahead of print].
28. Schneider WJ， Hill HL Jr， Brown RG. Latissimus dorsi myocutaneous flap for breast reconstruction [J]. Br J Plast Surg， 1977，30(4)：277-281.
29. Spiegel AJ， Eldor L. Partial breast reconstruction with mini superficial inferior epigastric artery and mini deep inferior epigastric perforator flaps [J]. Ann Plast Surg， 2010， 65(2)：147-154.
30. McCulley SJ， Macmillan RD， Rasheed T. Transverse upper gracilis (TUG) flap for volume replacement in breast conserving surgery for medial breast tumours in small to medium sized breasts [J]. J Plast Reconstr Aesthet Surg， 2011， 64(8)：1056-1060.
31. Fattah A， Figus A， Mathur B， et al. The transverse myocutaneous gracilis flap：technical refinements [J]. J Plast Reconstr Aesthet Surg， 2010， 63(2)：305-313.
32. Lee J， Bae Y， Audretsch W. Combination of two local flaps for large defects after breast conserving surgery [J]. Breast， 2012，21(2)：194-198.
33. Zaha H， Sunagawa H， Kawakami K， et al. Partial breast reconstruction for an inferomedial breast carcinoma using an omental flap [J]. World J Surg， 2010， 34(8)：1782-1787.
34. Illouz YG， Sterodimas A. Autologous fat transplantation to the breast： a personal technique with 25 years of experience [J].Aesthetic Plast Surg， 2009， 33(5)：706-715.
35. 方彰林主編. 乳房美容整形外科手術(shù)學(xué) [ M]. 北京出版社，1994：144-145.
36. Patel KM， Hannan CM， Gatti ME， et al. A head-to-head comparison of quality of life and aesthetic outcomes following immediate，staged-immediate， and delayed oncoplastic reduction mammaplasty [J]. Plast Reconstr Surg， 2011， 127(6)：2167-2175.
  1. 1. Veronesi U， Salvadori B， Luini A， et al. Conservative treatment of early breast cancer：long-term results of 1 232 cases treated with quadrantectomy， axillary dissection， and radiotherapy [J].Ann Surg， 1990， 211(3)：250-259.
  2. 2. Yu KD， Di GH， Wu J， et al. Development and trends of surgical modalities for breast cancer in China： a review of 16-year data[ J].Ann Surg Oncol， 2007， 14(9)：2502-2509.
  3. 3. Veronesi U， Cascinelli N， Mariani L， et al. Twenty-year followup of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer [J]. N Engl J Med， 2002， 347(16)：1227-1232.
  4. 4. Chan SW， Cheung PS， Lam SH. Cosmetic outcome and percentage of breast volume excision in oncoplastic breast conserving surgery [J]. World J Surg， 2010， 34(7)：1447-1452.
  5. 5. Klassen AF， Pusic AL， Scott A， et al. Satisfaction and quality of life in women who undergo breast surgery：a qualitative study [J]. BMC Womens Health， 2009， 9：11-19.
  6. 6. Veiga DF， Veiga-Filho J， Ribeiro LM， et al. Quality-of-life and self-esteem outcomes after oncoplastic breast-conserving surgery [J]. Plast Reconstr Surg. 2010， 125(3)：811-817.
  7. 7. Tan M， Ung O. Alternative approaches for oncoplastic breast surgery [J]. Ann Surg Oncol， 2011， 18(1)：297-299.
  8. 8. 馬銀斌， 王彥銘， 李偉， 等. 乳暈切口及殘腔無縫合技術(shù)在乳腺良性腫塊切除術(shù)中的應(yīng)用 [J]. 中國美容醫(yī)學(xué)， 2010， 19(5)：3-4.
  9. 9. Veiga DF， Veiga-Filho J， Ribeiro LM， et al. Evaluations of aesthetic outcomes of oncoplastic surgery by surgeons of different gender and specialty：a prospective controlled study [J]. Breast，2011， 20(5)： 407-412.
  10. 10. Fitoussi AD， Berry MG， Famà F， et al. Oncoplastic breast surgery for cancer：analysis of 540 consecutive cases [outcomes article] [J]. Plast Reconstr Surg， 2010， 125(2)：454-462.
  11. 11. Chakravorty A， Shrestha AK， Sanmugalingam N， et al. How safe is oncoplastic breast conservation? Comparative analysiswith standard breast conserving surgery [J]. Eur J Surg Oncol，2012， 38(5)：395-398.
  12. 12. Yang JD， Lee JW， Kim WW， et al. Oncoplastic surgical techniques for personalized breast conserving surgery in breast cancer patient with small to moderate sized breast [J]. J Breast Cancer，2011， 14(4)：253-261.
  13. 13. Meretoja TJ， Svarvar C， Jahkola TA， et al. Outcome of oncoplastic breast surgery in 90 prospective patients [J]. Am J Surg，2010， 200(2)：224-228.
  14. 14. 康驊， 朱江， 海濤， 等. 乳房整形技術(shù)在乳腺癌保乳手術(shù)中的應(yīng)用體會 [J]. 中國普外基礎(chǔ)與臨床雜志， 2011， 18(9)：917-921.
  15. 15. Urban C， Lima R， Schunemann E， et al. Oncoplastic principles in breast conserving surgery [J]. Breast， 2011， 20 Suppl 3：S92-S95.
  16. 16. Gainer SM， Lucci A. Oncoplastics： techniques for reconstruction of partial breast defects based on tumor location [J]. J Surg Oncol，2011， 103(4)：341-347.
  17. 17. Clough KB， Soussaline M， Campana F， et al. Mammoplasty combined with irradiation：conservative treatment of breast cancer localized in the lower quadrant [J]. Ann Chir Plast Esthet， 1990，35(2)：117-122.
  18. 18. Lassus C. A 30-year experience with vertical mammaplasty [J].Plast Reconstr Surg， 1996， 97(2)：373-380.
  19. 19. Clough KB， Kaufman GJ， Nos C， et al. Improving breast cancer surgery：a classification and quadrant per quadrant atlas for oncoplastic surgery [J]. Ann Surg Oncol， 2010， 17(5)：1375-1391.
  20. 20. Benelli L. A New periareolar mammaplasty：the “round block”technique [J]. Aesthetic Plast Surg， 1990， 14(2)：93-100.
  21. 21. Robbins TH. A reduction mammaplasty with the areola-nipple based on an inferior dermal pedicle [J]. Plast Reconstr Surg，1977， 59(1)：64-67.
  22. 22. Anderson BO， Masetti R， Silverstein MJ. Oncoplastic approaches to partial mastectomy：an overview of volume-displacement techniques [J]. Lancet Oncol， 2005， 6(3)：145-157.
  23. 23. Pennisi VR. Making a definite inframammary fold under a reconstructed breast [J]. Plast Reconstr Surg， 1977， 60(4)：523-525.
  24. 24. Kijima Y， Yoshinaka H， Hirata M， et al. Immediate reconstruction using a modified thoracodorsal adipofascial cutaneous flap after partial mastectomy [J]. Breast， 2011， 20(5)：464-467.
  25. 25. Ogawa T， Hanamura N， Yamashita M， et al. Long-term results of breast volume replacement using an inframammary adipofascial flap after breast-conserving surgery [J]. Breast Cancer， 2011 Jun28. [ Epub ahead of print].
  26. 26. Kijima Y， Yoshinaka H， Owaki T， et al. Immediate reconstruction using inframammary adipofascial flap of the anterior rectus sheath after partial mastectomy [J]. Am J Surg， 2007， 193(6)：789-791.
  27. 27. Aljarrah A， Nos C， Nasr R， et al. Updated follow-up of patients treated with the oncoplastic “Crescent” technique for breast cancer [J]. Breast， 2011 Dec 18. [ Epub ahead of print].
  28. 28. Schneider WJ， Hill HL Jr， Brown RG. Latissimus dorsi myocutaneous flap for breast reconstruction [J]. Br J Plast Surg， 1977，30(4)：277-281.
  29. 29. Spiegel AJ， Eldor L. Partial breast reconstruction with mini superficial inferior epigastric artery and mini deep inferior epigastric perforator flaps [J]. Ann Plast Surg， 2010， 65(2)：147-154.
  30. 30. McCulley SJ， Macmillan RD， Rasheed T. Transverse upper gracilis (TUG) flap for volume replacement in breast conserving surgery for medial breast tumours in small to medium sized breasts [J]. J Plast Reconstr Aesthet Surg， 2011， 64(8)：1056-1060.
  31. 31. Fattah A， Figus A， Mathur B， et al. The transverse myocutaneous gracilis flap：technical refinements [J]. J Plast Reconstr Aesthet Surg， 2010， 63(2)：305-313.
  32. 32. Lee J， Bae Y， Audretsch W. Combination of two local flaps for large defects after breast conserving surgery [J]. Breast， 2012，21(2)：194-198.
  33. 33. Zaha H， Sunagawa H， Kawakami K， et al. Partial breast reconstruction for an inferomedial breast carcinoma using an omental flap [J]. World J Surg， 2010， 34(8)：1782-1787.
  34. 34. Illouz YG， Sterodimas A. Autologous fat transplantation to the breast： a personal technique with 25 years of experience [J].Aesthetic Plast Surg， 2009， 33(5)：706-715.
  35. 35. 方彰林主編. 乳房美容整形外科手術(shù)學(xué) [ M]. 北京出版社，1994：144-145.
  36. 36. Patel KM， Hannan CM， Gatti ME， et al. A head-to-head comparison of quality of life and aesthetic outcomes following immediate，staged-immediate， and delayed oncoplastic reduction mammaplasty [J]. Plast Reconstr Surg， 2011， 127(6)：2167-2175.