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Breast Conservation Or Reconstruction, with evidence to choose!
As a hormone receptor-positive typing breast cancer patient, Ms. Wang underwent 7 neoadjuvant chemotherapy and complete surgery, and performed prosthetic reconstruction two years after the operation. She was deeply touched on the road to breast cancer diagnosis and treatment.
In order to help more breast cancer patients, Fudan University Affiliated Cancer Hospital and the medical community jointly held the " pink ribbon html June medical meeting" event. It was honored to invite Breast Surgery Department of Fudan University Affiliated Cancer Hospital Professor Wang Yan to have a dialogue with Ms. Wang, and the doctor and patient exchange face-to-face communication to answer questions related to breast cancer reconstruction surgery for breast cancer patients.
reconstruction timing and method, individualized choice is very important
Host: What is the current status of breast conservation surgery and breast reconstruction surgery for breast cancer patients? Which patients are suitable for?
Professor Wang Yan: Breast reconstruction and breast conservation surgery are important choices for breast cancer patients. Currently, more and more patients choose to retain or reshape the breast appearance after surgery. Compared with postoperative reconstruction, breast-conserving surgery is more suitable for single-effect lumps, including patients without diffuse malignant calcification and no contraindications for radiotherapy. For patients who are suitable for breast-conserving surgery, breast-conserving is preferred, and postoperative reconstruction is considered.
For patients who cannot undergo breast-conserving surgery or have contraindications for radiotherapy, phase I or phase II reconstruction after total resection is recommended. So which patients need to undergo a total mastectomy before considering reconstruction? It can be roughly divided into the following three categories:
. If the patient cannot maintain breast or the breast conservation surgery fails, and there are cancer cells involved in 1 incision margin, it is not recommended to retain breasts, and a complete resection is required;
2. If the patient has mutations in hereditary pathogenic genes such as BRCA1 or BRCA2, may increase the chance of subsequent secondary primary breast cancer, and it is also recommended to complete breast resection;
3. According to the patient's wishes, if the patient is unwilling to receive breast conservation and postoperative radiotherapy and wants to maintain his appearance, postoperative reconstruction is recommended.
Host: For mastectomy patients, how should we choose the best time for breast reconstruction?
Professor Wang Yan: Postoperative reconstruction includes immediate reconstruction and delayed reconstruction. has no definite time for postoperative reconstruction, and individualized suggestions will be made according to the patient's condition:
1. If the patient needs to undergo postoperative radiotherapy, radiotherapy will have an impact on the reconstruction appearance. It is recommended that the patient chooses autologous tissue reconstruction or delayed reconstruction.
2. If the patient considers not reconstructing for the time being, it is recommended to perform current surgery, chemotherapy, and radiotherapy first, and then consider subsequent choices after being mentally prepared. This is also a delayed reconstruction.
3. If the patient wants to reduce the impact of the surgery on subsequent life and appearance, he can choose to reconstruct immediately and retain a better appearance.
Host: Currently, in clinical practice, what are the breast reconstruction methods that breast cancer patients can choose?
Professor Wang Yan: Breast reconstruction includes implant reconstruction (prosthetic reconstruction), autologous flap reconstruction, and autologous flap combined with prosthetic reconstruction.
Prosthetic reconstruction is the most widely used reconstruction method at present. Foreign 70% ~ 80% of women will choose prosthetic implants to reconstruct, which does not require additional incisions, and can achieve better symmetrical effects through the implant. Moreover, the operation is relatively simple, with little trauma and quick recovery.
For some patients with large breasts or mild sagging, the prosthesis cannot achieve satisfactory results, and autologous flap reconstruction can be selected. Compared with prosthetic reconstruction, the advantage of autologous flap reconstruction is that it can obtain a more natural and soft and real appearance. The disadvantage is that it needs to be filled and shaped by its own tissue, which will cause certain damage to the donor area.
The two most widely used autologous flaps are two types of flaps, one is latissimus dorsi flaps . The back muscles are taken to combine with the patient's skin to repair the appearance of the breast. If the amount of tissue is insufficient, it may be necessary to implant with a small prosthesis. The other type of is the abdominal flap, which is usually called rectus abdominal flap. free rectus abdomen skin flap or perforated flap of the inferior abdominal artery (DIEP skin flap) is currently the best choice for breast reconstruction of autologous tissue flap.For patients, the abdominal flap can achieve a slimming effect when breast reconstruction is taken. Compared with prosthetic reconstruction, the autologous flap has more advantages in resisting subsequent radiotherapy.
Host: If radiotherapy is required, will "immediate reconstruction" affect the reconstruction effect?
Professor Wang Yan: autologous flap reconstruction/prosthetic reconstruction will not affect the patient's survival and will not increase recurrence. However, radiotherapy will affect the aesthetic effect of postoperative reconstruction, so different decisions will be made based on the order of postoperative reconstruction (including the choice of reconstruction method) based on whether the patient will receive radiotherapy after surgery.
Before the operation, it is clear that the patient is locally advanced and has received neoadjuvant treatment. Radiotherapy can reduce the local recurrence rate and is a necessary choice for patients. will recommend that patients consider autologous flap reconstruction, or use dilator two-step reconstruction, and to reduce the deformity and displacement caused by radiotherapy to the prosthesis.
Breast cancer prevents and avoids recurrence. The following points are very important.
Host: Is breast reconstruction safe? How should breast cancer patients avoid recurrence after reconstruction?
Professor Wang Yan: Evidence-based medical evidence proves that breast reconstruction will not increase the chance of breast cancer recurrence. Most of the implants used in are currently clinically used in silicone prosthesis, which is a material recognized by the China Medical Products Administration and the US FDA. Moreover, the risk of pathogenicity of rosy silicone prosthesis on the market is very low, and it is a very safe material.
is mainly divided into the following points for how to reduce the risk of breast cancer recurrence:
1. Active review after surgery is extremely important. Two to three years after is the high recurrence period, and it is recommended to have a re-examination every three months; it can have a half-year re-examination in three to five years; the risk of recurrence is low after five years, and physical examination and follow-up can be performed once a year.
2. It is crucial to receive regular treatment. Although breast cancer is a local disease, it is actually a systemic disease from the perspective of the principle of occurrence and development. Some patients need to receive systemic treatment after surgery, including chemotherapy, radiotherapy, endocrine therapy, etc. The cycle is relatively long. I hope each patient can continue to complete the treatment course. During the treatment process, many patients wonder why they need to take medication for a long time? The main reason is that as the disease progresses, the probability of recurrence is observed in the long run. Through long-term treatment, can further control the tumor in a chronic state and reduce the risk of disease recurrence and death.
3. Maintain a healthy lifestyle. Patients with breast cancer do not gain weight after surgery and do not accept high-calorie, greasy, and high-fat foods. Maintain low-fat diet , exercise and cheerful mood, which can maintain the treatment effect and reduce recurrence.
Host: The incidence of breast cancer is gradually increasing. How should breast cancer be scientifically prevented?
Professor Wang Yan: How to scientifically prevent breast cancer is a topic of concern to the public. is divided into controllable factors and uncontrollable factors from a medical perspective. Uncontrollable factors such as aging, congenital gene mutations, family history, dense breasts, benign breast diseases, etc. At this time, we need to pay attention to standardized treatment of diseases.
Some controllable factors include:
1, active physical examination: early detection and early treatment, and solve problems before cancer. It is recommended that women >40 years old undergo B ultrasound once a year, and they can be screened in combination with mammograms every 1-2 years.
2. Healthy diet: Breast cancer is a hormone-dependent tumor. It is recommended to reduce exogenous hormone intake, such as hormone replacement therapy or oral health products containing high estrogen and bird's nest. In addition, reducing the intake of alcohol can also help reduce the occurrence of tumors.
3. Healthy lifestyle: Smoking, obesity (higher BMI index) or type II diabetes are risk factors for breast cancer. Exercise frequently and maintain a normal body fat ratio is beneficial to health. Finally, avoid staying up late and have a normal schedule to prevent endocrine or hormone abnormalities.
Expert Profile
Wang Yan Professor
In 2003, I graduated from , Shanghai Medical College, Fudan University, , undergraduate major in clinical medicine, and later studied for a master's and doctoral degree in the surgical system rotation training of Zhongshan Hospital Affiliated to Fudan University.
In 2008, I received my Ph.D. in clinical medicine plastic surgery from Fudan University.After graduation, he has been working in the Department of Breast Surgery at the Affiliated Cancer Hospital of Fudan University.
In 2017, I went to Massachusetts General Hospital affiliated to Harvard University in the United States to study and exchange and study in the Dana-Farber Cancer Institute.
is good at breast tumor various surgical treatments, including local repair after breast conservation surgery and various breast reconstruction surgeries, as well as breast cancer genetic risk management. Participated in the compilation of many oncology-related clinical research projects and the writing of many works and books.
This article is first published: Medical community tumor channel
Author: Tangtang
Review of this article: Professor Wang Yan
Editor in charge: Sweet
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