Objective: To explore the application and effectiveness of three-pedicle reduction mammoplasty in breast cancer patients with moderate or greater breast hypertrophy and/or moderate-to-severe breast ptosis.
Methods: The clinical data of 15 breast cancer female patients with hypertrophy and/or moderate-to-severe breast ptosis treated by three-pedicle reduction mammaplasty with inverted T incision between January 2019 and March 2021 were retrospectively analysed. The patients were aged 31-58 years, with a median age of 39 years. The disease duration ranged from 10 days to 9 months (median, 3.4 months). All patients had unifocal tumor, with a maximum diameter of primary tumor of 0.5-3.9 cm (mean, 2.0 cm), of which 12 were diagnosed with invasive carcinoma and 3 carcinoma in situ. Tumor stage: T isN 0M 0 in 3 cases, T 1N 0M 0 in 4 cases, T 1N 2M 0 in 2 cases, T 2N 0M 0 in 4 cases, and T 2N 1M 0 in 2 cases. The preoperative cup sizes of patients were D cup in 3 cases, DD cup in 1 case, E cup in 2 cases, EE cup in 2 cases, F cup in 2 cases, FF cup in 1 case, and ≥G cup in 4 cases. The distance from nipple to inframammary fold was 8-18 cm (mean, 12.2 cm) before operation. The patients were followed up regularly after operation to evaluate the breast reduction effect and complications; Breast cancer reporting outcome scale (BREAST-Q) was used to assess patients' satisfaction and quality of life; and ultrasound, chest and abdominal CT, whole-body bone scan were performed to assess local tumor recurrence or distant metastasis.
Results: The postoperative nipple position was slightly higher than inframammary fold in all patients. Postoperative cup sizes were A cup in 3 cases, B cup in 6, C cup in 4, D cup in 1, and DD cup in 1, which showing significant difference when compared with preoperative cup sizes ( Z=3.420, P=0.001). The median follow-up time was 9 months (range, 6-33 months). Postoperatively, 2 cases (13.3%) had wound-site cellulitis, 1 (6.7%) had mild fat liquefaction, 2 (13.3%) had nipple and areola hypoesthesia but recovered after 3 months. No complication such as fat necrosis, papillary areola complex, or flap necrosis occurred. All patients had undergone adjuvant radiotherapy, of which 1 (6.7%) showed mild skin color change after radiotherapy, but no radiotherapy-related complication occurred in all patients. No patient was readmitted, received reoperation, or delayed to adjuvant therapy due to complications. In the BREAST-Q score, breast satisfaction and quality of life scores at 3 and 6 months after operation were significantly better than those before operation and at 1 month after operation ( P<0.05); no significant difference was found between at 1 month after operation and before operation ( P>0.05). Nipple satisfaction scores at 1, 3, and 6 months after operation were 15.6±2.2, 18.5±1.4, 19.3±0.7, respectively. At discharge after operation, the patient's satisfaction with the outcome of the operation was scored 84.7±11.4. The score of adverse events of radiotherapy at 6 months after operation was 6.5±0.8. During the follow-up, patient had no local recurrence, distant metastasis, or breast cancer related death.
Conclusion: For breast cancer patients with moderate or greater breast hypertrophy and/or moderate-to-severe breast ptosis, three-pedicle reduction mammoplasty can not only remove the lesions, but also reduce hypertrophic breasts, accomplish the mammoplasty, reduce the radiotherapy complications, and improve the satisfaction and quality of life of patients.
目的: 探讨三蒂法缩乳上提术治疗乳腺癌伴中度以上生理性乳房肥大和/或中重度乳房下垂患者的临床疗效。.
方法: 回顾分析2019年1月—2021年3月采用倒T形切口三蒂法缩乳上提术治疗的15例中度以上乳房肥大和/或中重度乳房下垂的女性乳腺癌患者。患者年龄31～58岁，中位年龄39岁。 病程10 d～9个月，中位病程3.4个月。肿瘤均为单发，最大径0.5～3.9 cm，平均2.0 cm。浸润性癌12例、原位癌3例；肿瘤分期：T isN 0M 0 3例，T 1N 0M 0 4例，T 1N 2M 0 2例，T 2N 0M 0 4例，T 2N 1M 0 2例。术前患者罩杯大小为D罩杯3例、DD罩杯1例、E罩杯2例、EE罩杯2例、F罩杯2例、FF罩杯1例、≥G罩杯4例。术前乳头至乳房下皱襞距离为8～18 cm，平均12.2 cm。术后定期随访，评估缩乳情况及并发症发生情况，采用乳腺癌患者报告结局量表（BREAST-Q）评价患者满意度及生活质量，并行乳腺专科彩超、胸腹部CT、全身骨扫描等检查，评估肿瘤局部复发或远处转移情况。.
结果: 术后乳头位置均略高于乳房下皱襞。术后患者罩杯大小为A罩杯3例，B罩杯6例，C罩杯4例，D罩杯1例，DD罩杯1例，与术前比较差异有统计学意义（ Z=3.420， P=0.001）。15例患者均获随访，随访时间6～33个月，中位时间9个月。2例（13.3%）出现术区蜂窝织炎，1例（6.7%）发生轻度脂肪液化，2例（13.3%）术后出现乳头感觉减退但在术后3个月有所恢复；无患者出现脂肪坏死、乳头乳晕复合体或皮瓣坏死等并发症。15例患者均已行辅助放疗，其中1例（6.7%）患者在放疗后出现乳房皮肤颜色改变，所有患者均未出现严重放疗不良事件并发症。无1例患者再次入院或再次手术，也无患者因并发症延缓辅助治疗。BREAST-Q评分中，术后3、6个月的乳房满意度及生活质量评分显著优于术前及术后1个月（ P<0.05）；术后1个月与术前比较差异均无统计学意义（ P>0.05）。术后1、3、6个月乳头满意度评分分别为（15.6±2.2）、（18.5±1.4）、（19.3±0.7）分。术后出院时患者对手术结局满意度评分为（84.7±11.4）分。术后6个月放疗不良事件评分为（6.5±0.8）分。随访期间无1例患者出现局部复发、远处转移及乳腺癌相关死亡。.
结论: 对于中度以上生理性乳房肥大和/或中重度乳房下垂的乳腺癌患者，三蒂法缩乳上提术既可以切除病灶，又可以缩小并悬吊乳房，减少放疗并发症，提高患者满意度及生活质量。.
Keywords: Breast cancer; breast hypertrophy; breast ptosis; reduction mammoplasty; three-pedicle technique.