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乳癌病人若是要做放射線治療,那還適合做義乳重建嗎?
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plasticsuper
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註冊時間: 2005-08-04
文章: 623
來自: 台北

發表 發表於: 星期三 十一月 09, 2005 4:12 pm
發表 文章主題: 乳癌病人若是要做放射線治療,那還適合做義乳重建嗎?
引言回覆

以前很常被病 人問到這個問題,有些乳癌病人在乳癌切除後,想要重建乳房,但是又不適合做自体組織重建。所以要做義乳(水袋或矽膠都可以)置入。但是她們怕之後的放射線治療或化學治療會不會對義乳有什麼影響。

美國著名的癌症中心 Memorial Sloan-Kettering Cancer Centre 在2005年10月的雜誌中解答了這個問題


Author McCarthy, Colleen M. M.D.; Pusic, Andrea L. M.D., M.H.S.; Disa, Joseph J. M.D.; McCormick, Beryl L. M.D.; Montgomery, Leslie L. M.D.; Cordeiro, Peter G. M.D.

Institution New York, N.Y.
From the Plastic and Reconstructive Service, Department of Surgery, the Department of Radiation Oncology, and Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center.

Title Unilateral Postoperative Chest Wall Radiotherapy in Bilateral Tissue Expander/Implant Reconstruction Patients: A Prospective Outcomes Analysis.[Article]

Abstract
Background: Implant reconstruction has a major role to play in breast reconstruction, as some patients neither wish nor are suitable for autogenous reconstruction. The suitability of implant reconstruction in patients who may receive postoperative, adjuvant radiation therapy has not, however, been fully clarified. The purpose of this study was to evaluate complications, capsular contracture, aesthetic outcomes, and patient satisfaction in patients who have undergone bilateral tissue expander/implant reconstruction and unilateral, post exchange, adjuvant radiotherapy. In this study population, the effect of radiation can best be appreciated because the nonirradiated breast acts as a control.

Methods: A review of all bilateral tissue expander/implant reconstructions at a single cancer center was undertaken. Twelve patients who underwent bilateral expander/implant reconstruction and unilateral postexchange radiotherapy were eligible for participation. A prospective evaluation of complications, cosmesis, and patient satisfaction was performed. The evaluation of cosmesis and patient satisfaction was executed for 10 of the 12 patients, as two were dead at the time of follow-up.

Results: Mean follow-up was 23.5 months (range, 12 to 58.5 years). In 40 percent of patients, there was no discernible difference in capsular contracture between the irradiated and nonirradiated breasts. In 50 percent of patients, the irradiated breast demonstrated increased contracture by a single modified Baker grade. In 10 percent of patients, contracture of the irradiated breast was two modified Baker grades greater than that of the nonirradiated side (grade III versus grade I).

Conclusion: For the majority of patients, the degree of capsular contracture was higher on the irradiated side, yet overall symmetry, aesthetic results, and patient satisfaction remained high. These data support the conclusion that immediate, bilateral breast reconstruction using tissue expansion and implants is an acceptable option for the subset of patients who may undergo unilateral, postexchange radiotherapy.

簡單的說就是:
1.化學治療對義乳沒有影響
2.放射線治療那一側比較容易產生莢膜孿縮( one Baker grade greater)
3.但是在美觀上大部份病人還是可以接受的




這個病人的右側有放射線治療,左側沒有。可以看到右側有稍微的孿縮,但與左側相較,不是很明顯。病人也還能接受。

_________________
With malice toward none, with charity for all

各位!電腦不要看太久,起身運動一下吧

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plasticsuper
Site Admin


註冊時間: 2005-08-04
文章: 623
來自: 台北

發表 發表於: 星期五 二月 24, 2006 1:34 pm
發表 文章主題:
引言回覆

又一篇支持上面的觀點

Author Ascherman, Jeffrey A. M.D.; Hanasono, Matthew M. M.D.; Newman, Martin I. M.D.; Hughes, Duncan B. M.D.

Institution New York, N.Y.
From the Department of Surgery, Division of Plastic Surgery, Columbia University Medical Center.

Title Implant Reconstruction in Breast Cancer Patients Treated with Radiation Therapy.

Source Plastic & Reconstructive Surgery. 117(2):359-365, February 2006.

Abstract
Background: Implant reconstruction in breast cancer patients treated with radiation therapy is controversial. Prior studies are limited by older prosthetic devices, reconstructive techniques, and radiation therapy protocols.

Methods: A retrospective review was performed of patients who underwent tissue expansion and implant breast reconstruction performed by a single surgeon after mastectomy for breast cancer from 1996 to 2003. Complications and aesthetic results were compared between patients who received radiation therapy and those who did not.

Results: A total of 104 patients (123 breasts) who underwent mastectomy and implant breast reconstruction were included in the study. Twenty-seven patients (27 breasts) received either premastectomy or postmastectomy radiation therapy for breast cancer. All patients who received radiation therapy did so before completion of their implant reconstruction. Complications ultimately requiring prosthetic device removal or replacement, as well as total complications (those requiring prosthetic removal or replacement and those not requiring prosthetic removal or replacement), were more frequent in breasts that received radiation than breasts that did not (18.5 percent versus 4.2 percent for complications requiring prosthetic removal or replacement, p <= 0.025, and 40.7 percent versus 16.7 percent for total complications, p <= 0.01). Breast symmetry was significantly better in patients who did not receive radiation compared with those who did (p < 0.01).

Conclusions: Implant breast reconstruction in patients who receive radiation therapy is possible but associated with more frequent complications and decreased aesthetic results. However, the present results compare favorably to those reported in prior studies. Improved results in the present study may be attributable to the use of newer prostheses, staged breast reconstruction with initial tissue expansion, total muscular coverage of the implant, and modern radiation therapy protocols.

這篇文章大意跟上一篇差不多,就是:要做電療的乳癌病患還是可以做義乳來重建,不過在美觀上會差一些,併發症的機會也比較高。本文最後做了項建議:先放組織擴張器來撐大乳房的皮膚,再換成永久性的義乳,並且把義乳放在胸大肌下方,這樣的結果會比較好。

_________________
With malice toward none, with charity for all

各位!電腦不要看太久,起身運動一下吧

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