Oncology Frontier:  Could you talk about the physical and emotional impact of breast reconstructive surgery today?

　　《肿瘤瞭望》：能否请您谈一下乳房再造术对乳腺癌患者生理及心理的影响？

　　Dr. MehraGolshan: So we have come a long way in terms of breast reconstruction where in the past it was just implant reconstruction where there were some tissue flaps but it has come a long way to many forms of implant reconstruction， both saline and silicon and what they call these gel modified versions. When we talk about using your own bodies tissue there is abdominal tissue and fat， bottom tissue and fat， and thigh tissue and fat that can be used for reconstruction which is especially with what I call “perforator flaps” this is very new and exciting. Technically they are very challenging operations， they take a long time to perform but they give the patient a very nice result. In the US we are very fortunate that reconstruction is paid for by insurance companies. In many Asian countries， I think the challenges， specifically in China， is that the patient often has to pay out of pocket for this. As healthcare standards continue to evolve in China， I think this is something the government is going to need to look at.

　　Mehra Golshan教授：目前乳房再造术已经走过了很长的发展道路，过去只是对尚存某些组织瓣的患者进行假体重建，而现在假体重建的形式大幅增加，有生理盐水和硅胶假体等。此外，还可以用患者的腹部、臀部、大腿的组织和脂肪等自体组织进行乳房再造。乳房重建最新穿支皮瓣技术的\效果振奋人心。从技术层面讲，这些手术非常具有挑战性，要花很长时间，但是效果好。在美国，幸运的是保险公司会为乳房再造术买单。对很多亚洲国家尤其是中国而言，我认为最大的挑战是患者通常需要自掏腰包支付乳房再造费用。随着中国医疗水平的发展，乳房再造的支付问题值得政府关注。

　　Oncology Frontier : Could you talk about neoadjuvant chemotherapy and its associated complications after skin sparing mastectomy?

　　《肿瘤瞭望》：能否请您谈一下新辅助化疗与保留皮肤的乳房切除术后并发症之间的相关性？

　　Dr. MehraGolshan: The good news with neoadjuvant therapy which is basically giving chemotherapy before surgery is that whether you do a skin sparring or nipple sparring or mastectomy without reconstruction， it looks like the complication rates are the same whether it is a skin sparring procedure or not. The issue is that one is the timing of the surgery， you want to make sure the surgery is done not too soon meaning that their blood counts are too low and they’re of higher risk for infection and not too late when the tumor starts waking up.

　　Mehra Golshan教授：手术前新辅助化疗治疗的优势在于：无论乳房切除术是否保留皮肤或乳头，其并发症的发生率均相似。关键在于手术时机的选择，在患者血细胞计数过低或感染风险太高时不能过早进行手术，又不能太晚手术以免肿瘤开始进展。

　　Oncology Frontier: Could you talk about what can be done preoperatively to reduce complications and improve aesthetic outcomes?

　　《肿瘤瞭望》：为减少术后并发症并提高美观效果，我们应该在术前做哪些准备工作？

　　Dr. MehraGolshan: Sometimes patients will ask， “should I drop some weight or add some weight? Should I exercise or not?” I think it is just they should keep what they have been doing in the past and not do any traumatic or drastic changes in their lifestyle to address this but certainly again but for those patients for example who are getting chemotherapy first before surgery， we always check their blood counts to make sure their hemoglobin has come back up and their white cell count is high enough to fight any infection adequately.

　　Mehra Golshan教授：有时候患者会问“我到底应该减重还是增重？我是否应该锻炼？”。对此我认为，患者应该坚持其原来的生活方式，不做大的变化。当然，对在手术前进行了化疗的患者而言，需要在术前对其进行血常规检查以确保其血红蛋白水平已恢复、白细胞计数足以充分对抗任何感染。

　　Oncology Frontier: Will you talk about your perspective on post mastectomy radiation therapy after immediate two stage tissue implant breast reconstruction?

　　《肿瘤瞭望》：您对乳腺癌切除术即刻两期乳房再造术后放疗持何观点？

　　Dr. MehraGolshan: The challenges of post mastectomy radiation on any form of reconstruction is that it makes the field that is being operated on at a much higher risk of complications， both in terms of healing if you try to put an implant in， there is also what you call capsular contracture which is a stiffening around the implant and there is a lot more need for revisional surgery. If you can put in what is called an expander or a placer and be able to finish the radiation then take that placeholder out and then put in a permanent reconstruction that is kind of a best case scenario. Or if the woman can wait until all of their therapy is done， meaning that the radiation is completed and waiting about 6 months to a year after that and then doing a tissue based reconstruction that usually ends up giving the best long term outcomes but of course many women want to go to the surgery and wake up with at least a part of their breast mound in place.

　　Mehra Golshan教授：无论术后采取任何形式的乳房重建，放疗都会使手术区的并发症风险增加。一方面，置入假体后存在愈合问题；另一方面，还可能会出现假体周围包膜痉挛，很多患者需要进行修复手术。最好的情况是，放入乳房扩张器并在放疗结束后取出，再进行永久性乳房重建。或者，如果等所有治疗结束后再进行乳房重建，即放疗结束后大约6个月~1年的时间才进行基于组织的乳房重建，患者的长期预后会最好。当然，很多女性还是想早点做乳房重建术。

　　Oncology Frontier: With that therapy in mind， what is the timing of radiation?

　　《肿瘤瞭望》：就这种治疗而言，放疗的时机是什么？

　　Dr. MehranGolshan: Usually radiation is Monday through Friday for about five and a half weeks after the completion of the surgery and the chemotherapy. Then we wait， if we can， for about 6 months after the completion of radiation to finish the reconstruction.

　　Mehra Golshan教授：通常情况下，放疗需要在完成手术及化疗后持续进行大约5.5周，每周从周一到周五。大约6个月后再进行乳房重建。