| Objective: With the increasing of the incidence of breast cancer,breast conserving surgery is the first choice for patients with early breast cancer.For the unilateral breast cancer patient combine with macromastia usually give up breast conserving because of the unaesthetic appearance of both sides after surgery,even preventive excision of contralateral breast,which seriously affected the quality of life of patients and postoperative satisfaction.Reduction mammaplasty is the first choice for the macromastia patient,which help them to solve the physical,mental and physical problems.In breast surgery and plastic surgery,many conflicting goals often emerging,for example aesthetic result,functional impact and patient satisfaction in the postoperative.With the increasing of the breast mastectomy and plastic surgery,aesthetic effect is one of the most important factors for patient’s prognosis.For a patient who has decades of life ahead of hers,a potential functional deficit could amount to decades of suboptimal function.The impact of this on quality of life and technical surgery is critical to keep in mind when the surgeon choosing a surgery method.The study combines breast conserving surgery with immediately reduction mammaplasty and analysis the clinical effect.Methods: We selected thirty-one patients with unilateral breast cancer and bilateral macromastia between October 2016 and December 2018.Breast cancer was diagnosed preoperatively by ultrasound-guided biopsy and macromastia was defined by breast size,volume and clinical symptoms.The patients were divided into the observation group and the control group according to different surgical methods.Eleven patients in the observation group received breast conserving surgery plus reduction mammaplasty and twenty patients in the control group received traditional breast conserving surgery.Postoperative cosmetic effect was assessed by American radiation therapy oncology group grade scale and visual analogue scale that aesthetic effect(the excellent and good rate of aesthetic)and satisfaction were compared between the two groups.Results: 1.In the observation group,eleven patients underwent unilateral breast conserving surgery and bilateral reduction mammaplasty.Ten patients performed sentinellymph node biopsy operation.One patient performed axillary lymph node dissection operation.The age of patients was 44.3±6.44 years old.Length of stay was 9.18±1.95 days.The following-up of patients was 13.09 ± 7.44 months.There were no obvious complications postoperative,distant metastases and local recurrence in period of following-up.All patients received radiotherapy.2.In the control group,twenty patients underwent unilateral breast conserving surgery.Fifteen patients performed sentinel lymph node biopsy operation.Five patients performed axillary lymph node dissection operation.The age of patients was 45.95±3.84 years old.Length of stay was 7.05±1.36 days.The following-up of patients was 14 ± 7.06 months.There were no obvious complications postoperative,distant metastases and local recurrence in period of following-up.all patients received radiotherapy.3.In the observation group,American radiation therapy oncology group grade scale cosmetic effect evaluation: ten cases were excellence and one case was good,the excellent and good rate of the patients was 100%.The satisfaction of visual analogue scale was 9.3±0.27.In the control group,American radiation therapy oncology group grade scale cosmetic effect evaluation: 1 case was excellent,4 cases were good,10 cases were average,and 5 cases were poor,the excellent and good rate of the patients was 25%.The satisfaction of visual analogue scale was6.13±0.30.The excellent and good rate of RTOG in the observation group was higher than the control group and the difference was statistically significant(P<0.01).The satisfaction of VAS in the observation group was higher than the control group and the difference was statistically significant(P<0.01).Conclusion: The use of reduction mammaplasty and breast conserving surgery can represent an advance in the management of the early breast cancer patient.In essence,this association defines the oncoplastic concept and refers to a number of surgical techniques by which tumors of breast tissue are removed to accomplish adequate surgical margins while the remaining glandular tissue is transposed to achieve a satisfactory esthetic outcome.The purpose is to improve esthetic outcomes after the conservative breast surgery and to address any other concerns the patient may have in regard to size and shape of the breast.For the unilateral breast cancer and bilateral macromastia patients who use of breast conserving surgery combined with immediately reduction mammaplasty,not only achieve the goal of the removal of the tumor,but also improvemacromastia distress,obtain better cosmetic effect and increase satisfaction,it has a broad development prospect and the worthy of clinical application. |
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