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DOI: 10.1055/a-1826-2992
Rekonstruktives Vorgehen zum Brustwiederaufbau bei geplanter Bestrahlung
Breast Reconstruction Strategies in Case of Planned Radiotherapy Finanzielle Unterstützung Die Autoren geben an, dass keine finanzielle Unterstützung erfolgt ist.Zusammenfassung
Einleitung Die ideale zeitliche und technische Vorgehensweise zur Brustrekonstruktion bei geplanter Radiatio nach vorausgegangener Mastektomie (Postmastektomie Radiotherapie; PMRT) wird weiterhin kontrovers diskutiert.
Methoden Die Autoren analysierten die MEDLINE Datenbank PubMed hinsichtlich Studien, die PMRT und Brustrekonstruktion thematisierten. Die Kernaussagen dieser Studien wurden extrahiert und zusammengefasst.
Ergebnisse Ein Implantat-basiertes rekonstruktives Vorgehen stellt die am wenigsten invasive zeitnahe Variante in einem PMRT-Setting dar und resultiert in einem sofortigen Brustwiederaufbau. Eine Rekonstruktion mit einem zweizeitigen Vorgehen durch ein Expander-Implantat bzw. Expander-Implantat-autologes Vorgehen ermöglicht gute bis exzellente Resultate. Verglichen mit der heterologen Vorgehensweise, resultieren autologe Rekonstruktionsverfahren in einer besseren Lebensqualität, haptisch-sensorischen Vorteilen und sind in der Regel mit einer geringeren Komplikationsrate assoziiert. Eine PMRT nach bereits durchgeführter autologer Rekonstruktion kann mit negativen ästhetischen Ergebnissen assoziiert sein. Ein delayed autologes Vorgehen kann vorteilhaft sein und sollte insbesondere bei Hochrisikopatientinnen favorisiert werden.
Zusammenfassung Faktoren, die in die sorgfältige Planung einer Brustrekonstruktion bei notwendiger PMRT einbezogen werden müssen, sind chirurgischer und ästhetischer Natur, beinhalten die Lebensqualität sowie Charakteristika, Wunsch und Erwartungshaltung der jeweiligen Patientin. Die autologe Rekonstruktion sollte im Idealfall nach der PMRT stattfinden, um potentiell negativ beeinträchtigende Einflüsse auf das eigengewebliche Resultat zu vermeiden. Falls eine PMRT wahrscheinlich ist, aber möglicherweise nicht notwendig wird, kann eine immediate-delayed Vorgehensweise vorteilhaft sein.
Abstract
Introduction The ideal technical and chronological approach of breast reconstruction in case of planned radiotherapy after mastectomy (post-mastectomy radiotherapy, PMRT) continues to be controversially discussed.
Methods The authors analysed the MEDLINE Database PubMed for relevant studies concerning PMRT and breast reconstruction. The main theses from these publications were extracted and summarised.
Results An implant-based approach is the least invasive technique for immediate breast-mound formation in a PMRT setting. Reconstruction in a PMRT setting with a two-stage expander-implant technique or expander-implant-autologous procedure can provide good to excellent cosmetic outcomes. In contrast to the implant-based approach, autologous reconstruction methods provide an improved quality of life as well as haptic and sensory advantages and are usually associated with lower complication rates. PMRT after autologous reconstruction can have a negative impact on the autologous tissue. A delayed autologous approach can be advantageous and should be generally favoured in high-risk patients.
Conclusion Factors influencing a meticulous planning of breast reconstruction including PMRT are surgical, aesthetic and patient characteristics, quality of life, preference and expectation. Ideally, PMRT is completed before autologous reconstruction to avoid radiation-associated side-effects on the final reconstructive result. If PMRT is likely, but potentially not necessary, an immediate-delayed procedure may be of advantage.
Schlüsselwörter
Postmastektomie Radiotherapie - PMRT - DIEP Lappenplastik - Radiatio - DIEP flap - radiation - radiotherapy - autologous breast reconstruction - autologe Brustrekonstruktion - post-mastectomy radiotherapyPublikationsverlauf
Eingereicht: 01. Dezember 2021
Angenommen: 29. März 2022
Artikel online veröffentlicht:
21. Juni 2022
© 2022. Thieme. All rights reserved.
Georg Thieme Verlag KG
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