Background:Conservative mastectomy with prepectoral breast reconstruction is becoming increasingly widespread and validated in recent years. Today, while aesthetic advantages and improvement in quality-of-life outcomes are widely acknowledged, oncological safety remains subject of debate. There is limited evidence on residual breast tissue after conservative mastectomy, and it still represents an unknown risk for local recurrence. The recent spread of this surgical technique precludes a standardized surgical approach in case of local recurrence of ipsilateral breast cancer, and the lack of evidence in the literature complicates the decision-making process. The objective of this study is to describe the surgical treatment of local relapses for breast cancer patients following conservative mastectomy and prepectoral implant-based reconstruction.Methods:Between January 2018 and May 2024 at a single institution, 648 consecutive patients underwent conservative mastectomy and prepectoral reconstruction as their primary treatment. We identified 12 patients with T1-2 breast cancer who subsequently had histologically confirmed ipsilateral breast cancer recurrence and a local wide excision or radical mastectomy were performed. Each clinical case was discussed in a multidisciplinary meeting to define the most appropriate surgical treatment. At time of diagnosis of recurrence, patients with lymph node metastasis or systemic involvement were excluded from the study.Results:Among 648 consecutive patients who underwent conservative mastectomy, 12 with histologically confirmed ipsilateral breast cancer recurrence were included. The mean interval to recurrence was 43 months (range 10–76 months) from the primary operation. Recurrence sites were as follows: upper outer quadrant in four patients (33.4%), upper inner quadrant in three (25.0%), lower inner quadrant in two (16.6%), lower outer quadrant in one (8.4%), and central quadrant with nipple involvement in two (16.6%). Of the 12 patients, 9 (75%) underwent wide local excision, including 2 who also received partial capsulectomy, while 3 (25%) required radical mastectomy with implant removal. Adjuvant radiation therapy was administered to 6 patients (50%)—5/6 (83.3%) in the excision group and 1/6 (16.7%) in the mastectomy group. No significant differences were observed in distant disease–free survival or overall survival between the two groups.Conclusions:Currently, surgical treatment of ipsilateral breast tumor recurrence following conservative mastectomy and prepectoral breast reconstruction is not reported in the literature, and this study represents the first instance where wide local excision is described. The management of ipsilateral recurrence should be discussed in multidisciplinary meetings and could be performed safely in selected cases, sparing the prosthesis and avoiding radical mastectomy.
背景：近年来，保留皮肤的乳房切除术联合胸肌前乳房重建术的应用日益广泛并得到验证。目前，尽管其美学优势及对生活质量的改善已获广泛认可，但其肿瘤学安全性仍存争议。关于保留皮肤的乳房切除术后残余乳腺组织的证据有限，这仍是局部复发的一个未知风险。该手术技术近年来的普及导致同侧乳腺癌局部复发时缺乏标准化手术方案，且文献证据的不足使决策过程复杂化。本研究旨在描述接受保留皮肤的乳房切除术及胸肌前假体重建术的乳腺癌患者局部复发的手术治疗方法。 方法：2018年1月至2024年5月期间，在同一机构连续有648例患者接受保留皮肤的乳房切除术及胸肌前重建术作为初始治疗。我们从中筛选出12例T1-2期乳腺癌患者，这些患者后续出现经组织学证实的同侧乳腺癌复发，并接受了局部广泛切除术或根治性乳房切除术。每个临床病例均经多学科会议讨论以确定最适宜的手术方案。复发确诊时，存在淋巴结转移或全身转移的患者被排除在研究之外。 结果：在648例接受保留皮肤的乳房切除术的连续患者中，12例经组织学证实同侧乳腺癌复发的患者被纳入研究。从初次手术到复发的平均间隔时间为43个月（范围10-76个月）。复发部位分布如下：外上象限4例（33.4%），内上象限3例（25.0%），内下象限2例（16.6%），外下象限1例（8.4%），中央象限累及乳头2例（16.6%）。12例患者中，9例（75%）接受了广泛局部切除术，其中2例同时行部分包膜切除术；3例（25%）需行根治性乳房切除术并移除假体。6例患者（50%）接受了辅助放疗，其中切除组5/6例（83.3%），乳房切除组1/6例（16.7%）。两组间在无远处转移生存率或总生存率方面未观察到显著差异。 结论：目前，文献中尚未报道保留皮肤的乳房切除术联合胸肌前乳房重建术后同侧乳腺肿瘤复发的手术治疗方案，本研究首次描述了广泛局部切除术在此类情况中的应用。同侧复发的处理应通过多学科会议讨论，在经选择的病例中可安全实施，既能保留假体，又可避免根治性乳房切除术。
肿瘤(癌症)患者之家