Meme Kanserinde Prostetik Onarım
Özet
Meme kanseri nedeniyle mastektomi geçiren hastalarda prostetik meme rekonstrüksiyonu, daha kısa işlem süresi, donör alan morbiditesinin olmaması ve düşük maliyet gibi avantajlarıyla öne çıkan güvenli bir seçenektir. Tedavi süreci kanserin evresine ve hastanın özelliklerine göre mastektomi sırasında hemen ya da doku genişletici kullanılarak iki aşamalı gecikmiş onarım şeklinde planlanabilir. Hemen yapılan onarımlar estetik ve psikososyal açıdan yüksek hasta memnuniyeti sağlasa da, gecikmiş onarımlara kıyasla daha yüksek komplikasyon oranlarına sahiptir. Prostetik onarımın en yaygın komplikasyonları kapsüler kontraktür, hematom ve enfeksiyon olup; özellikle sigara kullanımı, obezite, büyük implant hacmi ve diyabet gibi faktörler başarısızlık riskini artırmaktadır. Ayrıca adjuvan radyoterapi uygulaması, dokuların sertleşmesine ve ileri evre kapsüler kontraktür riskinin belirgin şekilde artmasına neden olarak estetik sonuçları ve hasta memnuniyetini olumsuz etkileyebilir. Protez seçiminde ise silikon ve pürtüklü implantların, salin ve düz olanlara kıyasla daha az dalgalanma, daha esnek kapsül oluşumu ve daha yüksek hasta memnuniyeti sağladığı görülmektedir. Sonuç olarak, çeşitli cerrahi risklere ve revizyon ihtiyaçlarına rağmen, protezle meme rekonstrüksiyonu hastaların yaşam kalitesini ve sosyal ilişkilerini anlamlı derecede düzelterek vücut bütünlüğü hissini geri kazandırmaktadır.
Prosthetic breast reconstruction stands out as a safe option with advantages such as shorter operative time, absence of donor site morbidity, and lower costs for patients undergoing mastectomy due to breast cancer. The treatment process can be planned either as an immediate reconstruction during mastectomy or as a two-staged delayed reconstruction using tissue expanders, depending on the stage of cancer and patient characteristics. Although immediate reconstructions provide high patient satisfaction aesthetically and psychosocially, they carry higher complication rates compared to delayed repairs. The most common complications of prosthetic reconstruction are capsular contracture, hematoma, and infection; specifically, factors such as smoking, obesity, large implant volume, and diabetes increase the risk of reconstructive failure. Additionally, adjuvant radiotherapy significantly increases the risk of advanced-stage capsular contracture and tissue induration, negatively impacting aesthetic outcomes and patient satisfaction. Regarding prosthesis selection, silicone and textured implants provide less rippling, more flexible capsule formation, and higher satisfaction scores than saline and smooth ones. In conclusion, despite various surgical risks and revision requirements, prosthetic breast reconstruction significantly improves patients' quality of life and social relationships, restoring their sense of bodily integrity.
Referanslar
Hershman DL, Richards CA, Kalinsky K, et al. Influence of health insurance, hospital factors and physician volume on receipt of immediate post-mastectomy reconstruction in women with invasive and non-invasive breast cancer. Breast Cancer Res Treat 2012;136:535-45.
Reaby LL. Reasons why women who have mastectomy decide to have or not to have breast recon-struction. Plast Reconstr Surg 1998;101:1810-8.
Ng SK, Hare RM, Kuang RJ, et al. Breast reconstruction post mastectomy: patient satisfaction and decision making. Ann Plast Surg 2014. [Epub ahead of print].
DellaCroce FJ, Wolfe ET. Breast reconstruction. Surg Clin North Am 2013;93:445-54.
Walton L, Ommen K, Audisio RA. Breast reconstruction in elderly women breast cancer: a review. Cancer Treat Rev 2011;37:353-7.
Snell L, McCarthy C, Klassen A, et al. Clarifying the expectations of patients undergoing implant breast reconstruction: a qualitative study. Plast Reconstr Surg 2010;126:1825-30.
Salhab M, Al Sarakbi W, Joseph A, et al. Skin-sparing mastectomy and immediate breast reconstruction: patient satisfaction and clinical outcome. Int J Clin Oncol 2006;11:51-4.
Kronowitz SJ, Kuerer HM. Advances and surgical decision-making for breast reconstruction. Cancer 2006;107:893-907.
Racano C, Fania PL, Motta GB, et al. Immediate and delayed two-stage post-mastectomy breast recon-struction with implants. Our experience of general surgeons. Minerva Chir 2002;57:135-49.
Kim SW, Lee HK, Kang SM, et al. Short-term outcomes of immediate breast reconstruction using an implant or tissue expander after mastectomy in breast cancer patients. Breast Cancer 2014. [Epub ahead of print].
Roostaeian J, Sanchez I, Vardanian A, et al. Comparison of immediate implant placement versus the staged tissue expander technique in breast reconstruction, Plast Reconstr Surg 2012;129:909e-18e.
Chang LY, Hargreaves W, Segara D, et al. Experience in dermomyofascial pouch coverage of imme-diate implants following skin sparing reduction mastectomy. ANZ J Surg 2013;83:135-8.
Roostaeian J, Pavone L, Da Lio A, et al. Immediate placement of implants in breast reconstruction: patients selection and outcomes. Plast Reconstr Surg 2011;127:1407-16.
Spear SL, Spittler CJ. et al. Breast reconstruction with implants and expanders. Plast Reconstr Surg 2001;107:177-87; quiz 188.
Hodgson EL, Malata CM. Implant-based breast reconstruction following mastectomy. Breast Dis 2002;16:47-63.
Argenta LC. Controlled tissue expansion in reconstructive surgery. Br J Plast Surg 1984;37:520-9.
Kronowitz SJ. State of the art and science in postmastectomy breast reconstruction. Plast Reconstr Surg 2015;135:755e-71e.
August DA, Wilkins E, Rea T. Breast reconstruction in older women. Surgery 1994;115:663-8.
Gabriel SE, Woods JE, O'Fallon WM, et al. Complications leading to surgery after breast implantation. N Engl J Med 1997;336:677-82.
Tsoi B, Ziolkowski NI, Thoma A, et al. Safety of tissue expander/implant versus autologous abdominal tissue breast reconstruction in postmastectomy breast cancer patients: a systematic review and meta-analysis. Plast Reconstr Surg 2014;133:234-49.
Davies K, Allan L, Roblin P, et al. Factors affecting post-operative complications following skin sparing mastectomy with immediate breast reconstruction. Breast 2011;20:21-5.
Bailey MH, Smith JW, Casas L, et al. Immediate breast reconstruction: reducing the risks. Plast Reconstr Surg 1989;83:845-51.
Miller AP, Falcone RE. Breast reconstruction: systemic factors influencing local complications. Ann Plast Surg 1991;27:115-20.
Cowen D, Gross E, Rouannet P, et al. Immediate post-mastectomy breast reconstruction followed by radiotherapy: risk factors for complications. Breast Cancer Res Treat 2010;121:627-34.
Krueger EA, Wilkins EG, Strawderman M, et al. Complications and patient satisfaction following expander/ implant breast reconstruction with and without radiotherapy. Int J Radiat Oncol Biol Phys 2001;49:713-21.
Embrey M, Adams EE, Cunningham B, et al. A review of the literature on the etiology of capsular contracture and a pilot study to determine the outcome of capsular contracture interventions. Aesthetic Plast Surg 1999;23:197-206.
Cordeiro PG, McCarthy CM. A single surgeon’s 12- year experience with tissue expander/implant breast reconstruction: part II. An analysis of long-term complications, aesthetic outcomes, and patient satisfaction. Plast Reconstr Surg 2006;118:832-9.
Holmes JD. Capsular contracture after breast reconstruction with tissue expansion. Br J Plast Surg 1989;42:591-4.
Singh N, Reaven NL, Funk SE. Immediate 1-stage vs. tissue expander postmastectomy implant breast reconstructions: a retrospective real-world comparison over 18 months. J Plast Reconstr Aesthet Surg 2012;65:917-23.
Sullivan SR, Fletcher DR, Isom CD, et al. True incidence of all complications following immediate and delayed breast reconstruction. Plast Reconstr Surg 2008;122:19-28.
Collis N, Coleman D, Foo IT, et al. Ten-year review of a prospective randomized controlled trial of textured versus smooth subglandular silicone gel breast implants. Plast Reconstr Surg 2000;106:786-91.
Pinsolle V, Grinfeder C, Mathoulin-Pelissier S, et al. Complications analysis of 266 immediate breast reconstructions. J Plast Reconstr Aesthet Surg 2006;59:1017-24.
Virden CP, Dobke MK, Stein P, et al. Subclinical infection of the silicone breast implant surface as a possible cause of capsular contracture. Aesthetic Plast Surg 1992;16:173-9.
Patani N, Devalia H, Anderson A, et al. Oncological safety and patient satisfaction with skin-sparing mastectomy and immediate breast reconstruction. Surg Oncol 2008;17:97-105.
Gylbert L, Asplund O, Jurell G. Capsular contracture after breast reconstruction with silicone-gel and salinefilled implants: a 6-year follow-up. Plast Reconstr Surg 1990;85:373-7.
Macadam SA, Ho AL, Cook EF Jr, et al. Patient satisfaction and health-related quality of life following breast reconstruction: patient-reported outcomes among saline and silicone implant recipients. Plast Reconstr Surg 2010;125:761-71.
McCarthy CM, Klassen AF, Cano SJ, et al. Patient satisfaction with post-mastectomy breast recon-struction: a comparison of saline and silicone implants. Cancer 2010;116:5584-91.
Macadam SA, Ho AL, Lennox PA, et al. Patient-reported satisfaction and health-related quality of life following breast reconstruction: a comparison of shaped cohesive gel and round cohesive gel implant recipients. Plast Reconstr Surg 2013;131:431-41.
Brown MH, Shenker R, Silver SA. Cohesive silicone gel breast implants in aesthetic and reconstructive breast surgery. Plast Reconstr Surg 2005;116:768-79; discussion 780-1.
Nahabedian MY. Shaped versus round implants for breast reconstruction: indications and outcomes. Plast Reconstr Surg Glob Open 2014;2:e116.
Liu X, Zhou L, Pan F, et al. Comparison of the postoperative incidence rate of capsular contracture among different breast implants: a cumulative meta-analysis. PLoS One 2015;10:e0116071.
Shapiro MA. Smooth vs. rough: an 8-year survey of mammary prostheses. Plast Reconstr Surg 1989;84:449-57.
Maxwell GP, Falcone PA. Eighty-four consecutive breast reconstructions using a textured silicone tis-sue expander. Plast Reconstr Surg 1992;89:1022-34; discussion 1035-6.
Quinn TT, Miller GS, Rostek M, et al. Prosthetic breast reconstruction: indications and update. Gland Surg 2016;5(2):174-186.
Spear SL, Majidian A. Immediate breast reconstruction in two stages using textured, integrated-valve tissue expanders and breast implants: a retrospective review of 171 consecutive breast reconstructions from 1989 to 1996. Plast Reconstr Surg 1998;101:53-63.
Yanko-Arzi R, Cohen MJ, Braunstein R, et al. Breast reconstruction: complication rate and tissue expander type. Aesthetic Plast Surg 2009;33:489-96.
Kronowitz SJ, Hunt KK, Kuerer HM, et al. Delayed immediate breast reconstruction. Plast Reconstr Surg 2004;113:1617-28.
Rosson GD, Shridharani SM, Magarakis M, et al. Quality of life before reconstructive breast surgery: A preoperative comparison of patients with immediate, delayed, and major revision reconstruction. Microsurgery 2013;33:253-8.
Clough KB, O'Donoghue JM, Fitoussi AD, et al. Prospective evaluation of late cosmetic results following breast reconstruction: I. Implant reconstruction. Plast Reconstr Surg 2001;107:1702-9.
Singh NK, Reaven NL, Funk SE. Cost comparison of immediate one-stage and tissue-expander breast reconstructions after mastectomy in commercially insured patients. Manag Care 2013;22:36-43.
Giacalone PL, Rathat G, Daures JP, et al. New concept for immediate breast reconstruction for inva-sive cancers: feasibility, oncological safety and esthetic outcome of postneoadjuvant therapy immediate breast reconstruction versus delayed breast reconstruction: a prospective pilot study. Breast Cancer Res Treat 2010;122:439-51.
Fodor J, Gulyás G, Polgár C, et al. Radiotherapy and breast reconstruction: the issue of compatibility. Orv Hetil 2003;144:549-55.
Alderman AK, Wilkins EG, Kim HM, et al. Complications in postmastectomy breast reconstruction: two-year results of the Michigan Breast Reconstruction Outcome Study. Plast Reconstr Surg 2002;109:2265-74.
Gerber B, Marx M, Untch M, et al. Breast Reconstruction Following Cancer Treatment. Dtsch Arztebl Int 2015; 112: 593–600.
Francel TJ, Ryan JJ, Manson PN. Breast reconstruction utilizing implants: a local experience and comparison of three techniques. Plast Reconstr Surg 1993;92:786-94.
Kuske RR, Schuster R, Klein E, et al. Radiotherapy and breast reconstruction: clinical results and do-simetry. Int J Radiat Oncol Biol Phys 1991;21:339-46.
Lentz R, Ng R, Higgins SA, et al. Radiation therapy and expander-implant breast reconstruction: an analysis of timing and comparison of complications. Ann Plast Surg 2013;71:269-73.
Fodor J, Gulyás G, Polgár C, et al. Radiotherapy and delayed breast reconstruction with implant: ex-amination of compatibility. Magy Onkol 2002;46:323-6.
Cordeiro PG, Pusic AL, Disa JJ, et al. Irradiation after immediate tissue expander/implant breast re-construction: outcomes, complications, aesthetic results, and satisfaction among 156 patients. Plast Reconstr Surg 2004;113:877-81.
Rosato RM, Dowden RV. Radiation therapy as a cause of capsular contracture. Ann Plast Surg 1994;32:342-5.
Parsa AA, Jackowe DJ, Johnson EW, et al. Selection criteria for expander/implant breast reconstruction following radiation therapy. Hawaii Med J 2009;68:66-8.
Rusby JE, Waters RA, Nightingale PG, et al. Immediate breast reconstruction after mastectomy: what are the long term prospects? Ann R Coll Surg Engl 2010;92:193-7.
Losken A, Carlson GW, Schoemann MB, et al. Factors that influence the completion of breast recon-struction. Ann Plast Surg 2004;52:258-61; discussion 262.
Wong JS, Ho AY, Kaelin CM, et al. Incidence of major corrective surgery after post-mastectomy breast reconstruction and radiation therapy. Breast J 2008;14:49-54.
Albornoz CR, Matros E, McCarthy CM, et al. Implant breast reconstruction and radiation: a multicen-ter analysis of long-term health-related quality of life and satisfaction. Ann Surg Oncol 2014;21:2159-64.
Ringberg A, Tengrup I, Aspegren K, et al. Immediate breast reconstruction after mastectomy for can-cer. Eur J Surg Oncol 1999;25:470-6.
Asplund O, Körlof B. Late results following mastectomy for cancer and breast reconstruction. Scand J Plast Reconstr Surg 1984;18:221-5.
Klit A, Mejdahl MK, Gärtner R, et al. Breast reconstruction with an expander prosthesis following mastectomy does not cause additional persistent pain: a nationwide cross-sectional study. J Plast Reconstr Aesthet Surg 2013;66:1652-8.
Corsten LA, Suduikis SV, Donegan WL. Patient satisfaction with breast reconstruction. Wis Med J 1992;91:125-6, 129.
