[Keyword] breast cancer; breast-conserving; cosmetic results; shaping
With the in-depth understanding of biological characteristics of breast cancer, breast-conserving surgery (breast conserving therapy BCT) is being more and more doctors and patients to accept. There are a number of clinical randomized controlled trials to prove the BCT with modified radical mastectomy can achieve the same recurrence-free survival and overall survival .
October 2001 to May 2007, we will be admitted to our hospital 176 cases of Ⅰ and Ⅱ breast cancer patients were randomly divided into two groups of A, B, A group of 85 cases of patients with breast-conserving surgery plus postoperative radiotherapy method of treatment. Group B, 91 cases of patients with breast modified radical surgery. Two groups of patients were followed up after surgery.
1 Clinical data and methods
1.1 General Information
A group of 85 patients, aged 23 to 46 years, with an average of 35.3 years old. Tumor diameter 2.1 ~ 3.0cm 29 cases, 1.1 ~ 2.0cm in 45 cases, less than 1.0cm in 11 cases. The tumor is located in the upper outer quadrant in 34 cases, in six cases, within the previous eight cases, four cases within, within the next 14 cases, in the next eight cases outside under the nine cases, two cases of Chinese and foreign. Including carcinoma in situ, 16 cases of carcinoma in situ, early invasive 13 cases of invasive carcinoma in 56 cases. Axillary lymph node dissection of 85 cases, including three cases of lymph node metastasis, 1, 1, and 3, respectively. The 6th edition of the TNM staging in accordance with the American Joint Committee on Cancer (American Joint Committee on Cancer, AJCC) breast cancer (2003)  restaging: 55 cases of Ⅰ Ⅱ (a) of the 28 cases, Ⅱ b, 2 cases. This group all rows preoperative mammography X-ray radiography, to postoperative All adjuvant chemotherapy and radical radiotherapy and endocrine therapy.
Group B, 91 patients, aged 30 to 53 years, with an average age of 38.9 years old. Were 33 cases of tumor diameter 2.1 ~ 3.0cm, 1.1 ~ 2.0cm in 46 patients, less than 1.0cm in 12 cases. The tumor is located in the upper outer quadrant in 42 cases, seven cases on, within the previous eight cases, six cases within, within the next seven cases, in the next six cases, under the outer quadrant in 13 cases, and two cases of Chinese and foreign. Modified radical mastectomy (reserved chest size muscle) in 58 cases, modified radical mastectomy (eliminate the pectoralis minor muscle retention pectoralis major) 33 cases. Six cases of lymph node metastasis, respectively, 2, 3, 2, 1, 3, 3. The 6 patients had no lymph node fusion. In accordance with AJCC breast cancer TNM stage version 6 re-staging: 56 cases of Ⅰ, Ⅱ (a) of the 31 cases, Ⅱ b of four cases . All postoperative adjuvant chemotherapy and endocrine therapy. Lymph node metastasis in patients with radiotherapy. A and B patients were followed up. The follow-up time of 6 months to 6 years. Table 2 A, group B patients after cosmetic results Survey Tables
1.2 Principles of Surgery Paul milk
1.2.1 surgical indications (1) Breast sufficient volume to ensure that the postoperative breast is not obvious deformation; (2) tumor single diameter ≤ 3.0cm; (3) tumor and nipple spacing ≥ 3cm; (4) the tumor has not invaded pectoral muscle and skin; (5) physical examination does not touch the ipsilateral axillary lymph nodes; (6) after radical radiotherapy, and long-term follow-up; (7) patients who have orthopedic technology and radical mastectomy techniques; (8) patients and their families to the requirements and expectations of breast-conserving therapy.
1.2.2 contraindication for surgery (1) multiple tumors; (2) extensive calcification; extensive intraductal carcinoma component (3); (4) pregnancy or lactation; (5) breast skin diseases can not receive radiotherapy.
Basic requirements of 1.2.3 surgery (1) gland line segment resection, cutting edge away from the tumor margin ≥ 3cm, the pathologically proven cutting edge residual cancer surgery. (2) invasive carcinoma close to the skin to remove the tumor above the skin, close to the pectoral muscle removal of partial pectoral muscle; early cancer (carcinoma in situ and carcinoma in situ of the early infiltration) No. (3) invasive cervical cancer should also axillary lymph node dissection; whether the cancer early.
2.1 of survival and recurrence
The follow-up rate of 100%, up from 6 months to 75 months. The median follow-up time was 40 months. After SPSS software testing local recurrence rate in group A, B (χ2 = 0.327, P = 0.568), distant metastasis (χ2 = 0.544, P = 0.461) and mortality (χ2 = 0.557, P = 0.456) difference not statistically significant, as shown in Table 1.
2.2 cosmetic results
According to the American College of Surgeons and radiotherapy Society, the College of American Pathologists and the Society of Surgical Oncology joint meeting recommended, and in JCRT  Application standard: excellent – almost no difference compared with the untreated side of the breast; well – a tiny difference; generally – significant differences; poor – treatment after breast aesthetic defects.
Cases in this study, short-term incision organizations hard at the skin incision or nipple numbness. 3 to 6 months after the scar softening, sensory recovery, satisfaction with breast appearance, as shown in Table 2.
Halsted (1894) created a radical mastectomy, and subsequently modified radical mastectomy as a traditional treatment for over half a century. In recent years, many other factors to promote breast-conserving surgery for early breast cancer may become a routine surgery in Europe and the United States and other Western countries have been carried out .