Cirugía oncoplástica en cáncer de mama
Palabras clave:
enfermedades de la mama, neoplasias de la mama, mamoplastiaResumen
El cáncer de mama es la enfermedad maligna más frecuente en la mujer; en el año 2002, se presentaron 209.995 casos nuevos con 42.913 muertes en los Estados Unidos y en Colombia, 5.526 casos nuevos con 2.253 muertes.
A partir de los estudios de Fisher, que demostraron que el cáncer de mama era la manifestación local de una enfermedad sistémica, el manejo quirúrgico cambió de manera importante hacia la cirugía conservadora, la cual debe cumplir dos requisitos básicos, como son, resecciones oncológicas que garanticen el control local de la enfermedad y resultados estéticos aceptables. Todo esto disminuye el impacto emocional en la mujer de no sufrir las secuelas de una mutilación o de las deformidades dejadas por la resección de tumores. Este nuevo enfoque ha permitido el desarrollo de la cirugía oncoplástica.
Este artículo describe 19 elementos que se deben tener en cuenta para el diagnóstico y la resección adecuada del tumor y, a su vez, ilustra y describe 10 técnicas de reconstrucción oncoplástica de mama, útiles en el manejo de pacientes cuya relación seno-tumor sea favorable, es decir, que al practicar una cirugía oncológicamente adecuada queda el suficiente tejido para, con colgajos glándulo-cutáneos e injertos, realizar la restauración inmediata de la mama.
La recomendación es fortalecer el entrenamiento en la aplicación de estas técnicas y la conformación de equipos interdisciplinarios de cirujanos plásticos y oncólogos para ofrecer mejores resultados oncológicos y estéticos en el mismo acto quirúrgico.
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Referencias bibliográficas
1. International Agency for Research on Cancer. CANCER Mondial, Database: GLOBOCAN 2002 (Actualizado abril del 2008 - Acceso junio del 2008) Disponible en: http://www-dep.iarc.fr/
2. Rowland JH, Desmond KA, Meyerowitz BE, Belin TR, Wyatt GE, Ganz PA. Role of breast reconstructive surgery in physical and emotional outcomes among breast cancer survivors. J Natl Cancer Inst. 2000;92:1422-9.
3. Nano MT, Gill PG, Kollias J, Bochner MA, Malycha P, Winefield HR. Psychological impact and cosmetic outcome of surgical breast cancer strategies. ANZ J Surg. 2005;75:940-7.
4. Nicholson RM, Leinster S, Sassoon EM. A comparison of the cosmetic and psychological outcome of breast reconstruction, breast conserving surgery and mastectomy without reconstruction. The Breast. 2007;16:396-410.
5. Abaúnza H. Cáncer mamario: factores pronósticos. Rev Colomb Cir.1993;8:24-9.
6. Abaúnza H. Cáncer mamario: factores de riesgo. Rev Colomb Cir. 1993;8:2-6.
7. Robledo JF. Reconstrucción mamaria posmastectomía. Rev Colomb Cir. 1993;8:45-50.
8. Veronesi U, Salvadori B, Luini A. Breast conserving is a safe method in patients with small cancer of the breast. Long-term results of three randomized trials on 1,973 patients. Eur J Cancer J Cancer. 1995;31:1574-9.
9. Fisher B, Anderson S, Redmond CK, Wolkmark N, Wickerham DL, Cronin WM. Reanalysis and results after 12 years of follow-up in a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med. 1995;333:1456-61.
10. Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch N, Fisher ER, et al. Twenty-year follow-up a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347:1233-41.
11. Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A, Aguilar M, Marubini E. Twenty-year follow-up of a randomized study comparing breast conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002;347:1227-32.
12. Asgeirsson KS, Rasheed T, McCulley SJ, Macmillan RD. Oncological and cosmetic outcomes of oncoplastic breast conserving surgery. EJSO. 2005;31:817-23.
13. Rietjensa M, Urbana CA, Reya PC. Long-term oncological results of breast conservative treatment with oncoplastic surgery. The Breast. 2007;16:387-95.
14. Kroll SS, Frederick A, Singletary SE, Schusterman MA. The oncologic risks of skin preservation at mastectomy when combined with immediate reconstruction of the breast. Surg Gynecol Obstet. 1991;172:17-20.
15. Maldonado H. Tratamiento conservador del cáncer mamario. Rev Col Cirugía.1993;8:30-6.
16. Audretsch W, Rezai M, Kolotas C, Zamboglou N, Schnabel Th, Bojar H. Onco-plastic surgery: “target” volumen reduction (BCT-mastopexy), lumpectomy reconstruction (BCT-reconstruction) and flapp-supported operability in breast cancer. Proceedings 2nd European Congress on senology; October 2-6, 1994; Vienna, Austria; Bologna, Italy, Monduzzi, 1994: 139-157.
17. Audretsch W, Rezai M, Kolotas C, Zamboglou N, Schnabel T, Bojar H. Tumor-specific immediate reconstruction in breast cancer patients. Perspect Plast Surg. 1998;11:71-106.
18. De la Rochefordiere A, Abner AL, Silver B, Vicini F, Recht A, Harris JR. Are cosmetic results following conservative surgery and radiation therapy for early breast cancer dependent on technique? Int J Radiat Oncol Biol Phys. 1992;23:925-31.
19. Taylor ME, Pérez CA, Halverson KJ, Kuske RR, Philpott GW, García DM, Mortimer JE, Myerson RJ, Radford D, Rush C. Factors influencing cosmetic results after conservation therapy for breast cancer. Int J Radiat Oncol Biol Phys. 1995;31:753-64.
20. Mills JM, Schultz DJ, Solin LJ. Preservation of cosmesis with low complication risk after conservative surgery and radiotherapy for ductal carcinoma in situ of the breast. Int J Radiat Oncol Biol Phys. 1997;39:637-41.
21. Cochrane R, Valasiadou P, Wilson A, Al-Ghazal SK, Macmillan RD. Cosmesis and satisfaction after breast-conserving surgery correlates with the percentage of breast volume excised. Br J Surg. 2003;90:1505-9.
22. Bredart A, Petit JY. Partial mastectomy: a balance between oncology and aesthetics? Lancet Oncol. 2005;6:130.
23. Asgeirsson KS, Rasheed T, McCulley SJ, Macmillan RD. Oncological and cosmetic outcomes of oncoplastic breast conserving surgery. Eur J Surg Oncol. 2005;31:817-23.
24. Oncoplastic breast surgery: a guide to good practice. Eur J Surg Oncol. 2007;33(Suppl.1):S1-23.
25. Masetti R, Di Leone A, Franceschini G, Magno S, Terribile D, Fabbri MC, et al. Oncoplastic techniques in the conservative surgical treatment of breast cancer: an overview. Breast J. 2006;12:S174-80.
26. Kraissl CJ. The selection of appropriate lines for elective surgical incisions. Plast Rec Surg. 1951;8:1-28.
27. Losken A, Styblo TM, Carlson GW, Jones GE, Amerson BJ. Management algorithm and outcome evaluation of partial mastectomy defects treated using reduction or mastopexy techniques annals of plastic surgery. 2007;59:235-42.
28. A Katz, EA Strom, TA Buchholz, HD Thames, CD Smith, A Jhingran, G Hortobagyi, AU Buzdar, R Theriault, SE Singletary and MD McNeese. Locoregional recurrence patterns after mastectomy and doxorubicin-based chemother-apy: implications for postoperative irradiation, Journal of Clinical Oncology 18 (2000), 2817-2827.
29. Olivari N. The latissimus flap. Br J Plast Surg. 1976;29:126.
30. Hartrampf CR, Scheflan M, Black PW. Breast reconstruction following mastectomy with a transverse abdominal island flap. Anatomical and clinical observations. Plast Reconstr Surg. 1982;69:216.
31. Audretsch WP. Reconstruction of the partial mastectomy defect: classificationand method. In: Spear SL, editor. Surgery of the breast: principles and art. Second ed. Philadelphia: Lippincott-Raven; 2006:179-213.
32. Benelli L. Technique de plastic mammaire: le round block. Rev Fr Chirurgie Esthetique. 1988;XIII:50.
33. Benelli L. A new periareolar mammaplasty: the “round block” technique. Aesthetic Plast Surg. 1990;14:93-100.
34. Góes JCS. Periareolar mammaplasty: double skin technique with application of polyglactin 910 mesh. Rev Soc Bras Cir Plast. 1992;7:1-3.
35. Góes JCS, Bostwick III J, Benelli L, Courtiss EH. Lejour M. Minimizing scars in breast surgery (expert exchange). Perspect Plast Surg. 1993;7:59-85.
36. López MC, Gareh N, Dubon O, Daurés JP, Robledo JF, Giocalone P. Cuadrantectomía con mastopexia tipo “donet” versus cuadrantectomía estándar en cáncer de seno: un estudio comparativo prospectivo. Rev Colomb Cirugía. 2006;21:39-47.
37. Goes JCS. Periareolar mammaplasty double-skin technique with application of mesh support. In: Spear SL, editor. Surgery of the breast: principles and art. Second ed. Philadelphia: Lippincott-Raven; 2006;179-213.
38. Masetti R, Di Leone A, Franceschini G, Magno S, Terribile D, Fabbri M, et al. Oncoplastic techniques in the conservative surgical treatment of breast cancer: an overview. Breast J. 2006;12:S174-80.
39. Grisotti A, Veronesi U. Reconstruction of the radiated partial mastectomy defect with autogenous tissue. Plast Reconstr Surg. 1992;90:866.
40. Grisotti A. Immediate reconstruction after partial mastectomy. Oper Techn Plast Reconstr Surg. 1994;1:1-12.
41. Schoeller T, Huemer GH. Immediate reconstruction of the nipple/areola complex in oncoplastic surgery after central quadrantectomy. Ann Plast Surg. 2006;57:611-5.
42. Huemer GM, Schrenk P, Moser F, Wagner E, Wayand W. Oncoplastic Techniques allow breast-conserving treatment in centrally located breast cancers. Plast Reconstr Surg. 2007;120:390.
43. Pezzi CM, Kukora JS, Audet IM, Herbert SH, Horvick D, Richter MP. Breast conservation surgery using nipple-areolar resection for central breast cancers. Arch Surg. 2004;139:32-7.
44. Pitanguy I. Surgical treatment of breast hypertrophy. Br J Plast Surg. 1967;20:78-85.
45. Robbins TH. A reduction mammaplasty with areola-nipple based on an inferior dermal pedicle. Plast Reconstr Surg. 1977;59:64.
46. Thornton BP, Stewart DH, McGrath PC, Pu LL. Breast reduction as an alternative treatment option for early breast cancer in women with macromastia. Ann Plast Surg. 2006;56:26-30.
47. Anderson BO, Masetti R, Silverstein MJ. Oncoplastic approaches to partial mastectomy: an overview of volume-displacement techniques. Lancet Oncol. 2005;6:145-7.
48. Spear SL, Pelletiere CV, Wolfe AJ, Tsangaris TN, Pennanen MF. Experience with reduction mammaplasty combined with breast conservation therapy in the treatment of breast cancer. Plast Reconstr Surg. 2003;111:1102-9.
49. Clough KB, Lewis JS, Couturaud B, Fitoussi A, Nos C, Falcou MC. Oncoplastic techniques allow extensive resections for breast-conserving therapy of breast carcinomas. Ann Surg. 2003;237:26-34.
2. Rowland JH, Desmond KA, Meyerowitz BE, Belin TR, Wyatt GE, Ganz PA. Role of breast reconstructive surgery in physical and emotional outcomes among breast cancer survivors. J Natl Cancer Inst. 2000;92:1422-9.
3. Nano MT, Gill PG, Kollias J, Bochner MA, Malycha P, Winefield HR. Psychological impact and cosmetic outcome of surgical breast cancer strategies. ANZ J Surg. 2005;75:940-7.
4. Nicholson RM, Leinster S, Sassoon EM. A comparison of the cosmetic and psychological outcome of breast reconstruction, breast conserving surgery and mastectomy without reconstruction. The Breast. 2007;16:396-410.
5. Abaúnza H. Cáncer mamario: factores pronósticos. Rev Colomb Cir.1993;8:24-9.
6. Abaúnza H. Cáncer mamario: factores de riesgo. Rev Colomb Cir. 1993;8:2-6.
7. Robledo JF. Reconstrucción mamaria posmastectomía. Rev Colomb Cir. 1993;8:45-50.
8. Veronesi U, Salvadori B, Luini A. Breast conserving is a safe method in patients with small cancer of the breast. Long-term results of three randomized trials on 1,973 patients. Eur J Cancer J Cancer. 1995;31:1574-9.
9. Fisher B, Anderson S, Redmond CK, Wolkmark N, Wickerham DL, Cronin WM. Reanalysis and results after 12 years of follow-up in a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med. 1995;333:1456-61.
10. Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch N, Fisher ER, et al. Twenty-year follow-up a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347:1233-41.
11. Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A, Aguilar M, Marubini E. Twenty-year follow-up of a randomized study comparing breast conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002;347:1227-32.
12. Asgeirsson KS, Rasheed T, McCulley SJ, Macmillan RD. Oncological and cosmetic outcomes of oncoplastic breast conserving surgery. EJSO. 2005;31:817-23.
13. Rietjensa M, Urbana CA, Reya PC. Long-term oncological results of breast conservative treatment with oncoplastic surgery. The Breast. 2007;16:387-95.
14. Kroll SS, Frederick A, Singletary SE, Schusterman MA. The oncologic risks of skin preservation at mastectomy when combined with immediate reconstruction of the breast. Surg Gynecol Obstet. 1991;172:17-20.
15. Maldonado H. Tratamiento conservador del cáncer mamario. Rev Col Cirugía.1993;8:30-6.
16. Audretsch W, Rezai M, Kolotas C, Zamboglou N, Schnabel Th, Bojar H. Onco-plastic surgery: “target” volumen reduction (BCT-mastopexy), lumpectomy reconstruction (BCT-reconstruction) and flapp-supported operability in breast cancer. Proceedings 2nd European Congress on senology; October 2-6, 1994; Vienna, Austria; Bologna, Italy, Monduzzi, 1994: 139-157.
17. Audretsch W, Rezai M, Kolotas C, Zamboglou N, Schnabel T, Bojar H. Tumor-specific immediate reconstruction in breast cancer patients. Perspect Plast Surg. 1998;11:71-106.
18. De la Rochefordiere A, Abner AL, Silver B, Vicini F, Recht A, Harris JR. Are cosmetic results following conservative surgery and radiation therapy for early breast cancer dependent on technique? Int J Radiat Oncol Biol Phys. 1992;23:925-31.
19. Taylor ME, Pérez CA, Halverson KJ, Kuske RR, Philpott GW, García DM, Mortimer JE, Myerson RJ, Radford D, Rush C. Factors influencing cosmetic results after conservation therapy for breast cancer. Int J Radiat Oncol Biol Phys. 1995;31:753-64.
20. Mills JM, Schultz DJ, Solin LJ. Preservation of cosmesis with low complication risk after conservative surgery and radiotherapy for ductal carcinoma in situ of the breast. Int J Radiat Oncol Biol Phys. 1997;39:637-41.
21. Cochrane R, Valasiadou P, Wilson A, Al-Ghazal SK, Macmillan RD. Cosmesis and satisfaction after breast-conserving surgery correlates with the percentage of breast volume excised. Br J Surg. 2003;90:1505-9.
22. Bredart A, Petit JY. Partial mastectomy: a balance between oncology and aesthetics? Lancet Oncol. 2005;6:130.
23. Asgeirsson KS, Rasheed T, McCulley SJ, Macmillan RD. Oncological and cosmetic outcomes of oncoplastic breast conserving surgery. Eur J Surg Oncol. 2005;31:817-23.
24. Oncoplastic breast surgery: a guide to good practice. Eur J Surg Oncol. 2007;33(Suppl.1):S1-23.
25. Masetti R, Di Leone A, Franceschini G, Magno S, Terribile D, Fabbri MC, et al. Oncoplastic techniques in the conservative surgical treatment of breast cancer: an overview. Breast J. 2006;12:S174-80.
26. Kraissl CJ. The selection of appropriate lines for elective surgical incisions. Plast Rec Surg. 1951;8:1-28.
27. Losken A, Styblo TM, Carlson GW, Jones GE, Amerson BJ. Management algorithm and outcome evaluation of partial mastectomy defects treated using reduction or mastopexy techniques annals of plastic surgery. 2007;59:235-42.
28. A Katz, EA Strom, TA Buchholz, HD Thames, CD Smith, A Jhingran, G Hortobagyi, AU Buzdar, R Theriault, SE Singletary and MD McNeese. Locoregional recurrence patterns after mastectomy and doxorubicin-based chemother-apy: implications for postoperative irradiation, Journal of Clinical Oncology 18 (2000), 2817-2827.
29. Olivari N. The latissimus flap. Br J Plast Surg. 1976;29:126.
30. Hartrampf CR, Scheflan M, Black PW. Breast reconstruction following mastectomy with a transverse abdominal island flap. Anatomical and clinical observations. Plast Reconstr Surg. 1982;69:216.
31. Audretsch WP. Reconstruction of the partial mastectomy defect: classificationand method. In: Spear SL, editor. Surgery of the breast: principles and art. Second ed. Philadelphia: Lippincott-Raven; 2006:179-213.
32. Benelli L. Technique de plastic mammaire: le round block. Rev Fr Chirurgie Esthetique. 1988;XIII:50.
33. Benelli L. A new periareolar mammaplasty: the “round block” technique. Aesthetic Plast Surg. 1990;14:93-100.
34. Góes JCS. Periareolar mammaplasty: double skin technique with application of polyglactin 910 mesh. Rev Soc Bras Cir Plast. 1992;7:1-3.
35. Góes JCS, Bostwick III J, Benelli L, Courtiss EH. Lejour M. Minimizing scars in breast surgery (expert exchange). Perspect Plast Surg. 1993;7:59-85.
36. López MC, Gareh N, Dubon O, Daurés JP, Robledo JF, Giocalone P. Cuadrantectomía con mastopexia tipo “donet” versus cuadrantectomía estándar en cáncer de seno: un estudio comparativo prospectivo. Rev Colomb Cirugía. 2006;21:39-47.
37. Goes JCS. Periareolar mammaplasty double-skin technique with application of mesh support. In: Spear SL, editor. Surgery of the breast: principles and art. Second ed. Philadelphia: Lippincott-Raven; 2006;179-213.
38. Masetti R, Di Leone A, Franceschini G, Magno S, Terribile D, Fabbri M, et al. Oncoplastic techniques in the conservative surgical treatment of breast cancer: an overview. Breast J. 2006;12:S174-80.
39. Grisotti A, Veronesi U. Reconstruction of the radiated partial mastectomy defect with autogenous tissue. Plast Reconstr Surg. 1992;90:866.
40. Grisotti A. Immediate reconstruction after partial mastectomy. Oper Techn Plast Reconstr Surg. 1994;1:1-12.
41. Schoeller T, Huemer GH. Immediate reconstruction of the nipple/areola complex in oncoplastic surgery after central quadrantectomy. Ann Plast Surg. 2006;57:611-5.
42. Huemer GM, Schrenk P, Moser F, Wagner E, Wayand W. Oncoplastic Techniques allow breast-conserving treatment in centrally located breast cancers. Plast Reconstr Surg. 2007;120:390.
43. Pezzi CM, Kukora JS, Audet IM, Herbert SH, Horvick D, Richter MP. Breast conservation surgery using nipple-areolar resection for central breast cancers. Arch Surg. 2004;139:32-7.
44. Pitanguy I. Surgical treatment of breast hypertrophy. Br J Plast Surg. 1967;20:78-85.
45. Robbins TH. A reduction mammaplasty with areola-nipple based on an inferior dermal pedicle. Plast Reconstr Surg. 1977;59:64.
46. Thornton BP, Stewart DH, McGrath PC, Pu LL. Breast reduction as an alternative treatment option for early breast cancer in women with macromastia. Ann Plast Surg. 2006;56:26-30.
47. Anderson BO, Masetti R, Silverstein MJ. Oncoplastic approaches to partial mastectomy: an overview of volume-displacement techniques. Lancet Oncol. 2005;6:145-7.
48. Spear SL, Pelletiere CV, Wolfe AJ, Tsangaris TN, Pennanen MF. Experience with reduction mammaplasty combined with breast conservation therapy in the treatment of breast cancer. Plast Reconstr Surg. 2003;111:1102-9.
49. Clough KB, Lewis JS, Couturaud B, Fitoussi A, Nos C, Falcou MC. Oncoplastic techniques allow extensive resections for breast-conserving therapy of breast carcinomas. Ann Surg. 2003;237:26-34.
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Publicado
2008-12-20
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Sánchez, N. B.; Rubiano, J. Cirugía oncoplástica En cáncer De Mama. Rev Colomb Cir 2008, 23, 217-229.
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Todos los textos incluidos en la Revista Colombiana de Cirugía están protegidos por derechos de autor. Las opiniones expresadas en los artículos firmados son las de los autores y no coinciden necesariamente con las de los directores o los editores de la Revista Colombiana de Cirugía. Las sugerencias diagnósticas o terapéuticas como elección de productos, dosificación y métodos de empleo corresponden a la experiencia y al criterio de los autores.
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