Nakagawa Tatsuhiro, Yano Kenji, Hosokawa Ko
Department of Plastic Surgery, National Kure Medical Center, Hiroshima, Japan.
Plast Reconstr Surg. 2003 Jan;111(1):141-7; discussion 148-9. doi: 10.1097/01.PRS.0000037863.12680.39.
If a patient's nipple-areola complex is available for grafting after mastectomy, it is the best material to use for nipple-areola reconstruction. The authors performed delayed autologous nipple-areola complex transfer to reconstructed breasts in 10 patients (mean age, 47 years; range, 40 to 53 years). The nipple-areola complex was cryopreserved with a programmed freezer after mastectomy. Histological examination of the tissue surrounding the nipple and areola eliminated the possibility of cancer invasion. At the time of transfer, the cryopreserved nipple-areola complex was thawed in 37 degrees C water and grafted on a projection made by a denuded dermal flap on the reconstructed breast. Each patient underwent immediate breast reconstruction using an innervated pedicled transverse rectus abdominis musculocutaneous (TRAM) flap. The patients' postoperative courses were uneventful. The timing of transfer ranged from 3 months to 1 year (mean, 5.8 months) after breast reconstruction. Nipple projection was made by the "four" dermal flap in five cases, a round dermal flap in three cases, a double dermal flap in one case, and a denuded skate flap in one case. The follow-up period ranged from 5 to 36 months (mean, 21.8 months). All grafts were adapted. The final evaluation of nipple-areola complex adaptation was good in four cases, fair in four cases, and poor in two cases. Histological examination of the hematoxylin and eosin stains showed no remarkable destruction of the skin of the nipple and areola, and electron microscopic examination of the areola skin revealed no significant change. However, electron microscopic examination of the nipple skin showed serious damage to skin components, including elongation of the desmosome, widening of the intercellular space at the prickle cell and basal layers, and shrinking of prickle and basal cells. Although further development of the freezing process and cryopreservation technique is needed to prevent depigmentation of the nipple and areola, cryopreserved nipple-areola complex transfer to a reconstructed breast could be an alternative method of nipple-areola reconstruction.
如果患者在乳房切除术后乳头乳晕复合体可供移植，那么它是用于乳头乳晕重建的最佳材料。作者对10例患者（平均年龄47岁，范围40至53岁）进行了延迟自体乳头乳晕复合体转移至重建乳房的手术。乳头乳晕复合体在乳房切除术后用程序降温冷冻器进行冷冻保存。对乳头和乳晕周围组织的组织学检查排除了癌症侵袭的可能性。在转移时，将冷冻保存的乳头乳晕复合体在37℃水中解冻，并移植到重建乳房上由去表皮真皮瓣形成的凸起处。每位患者均使用带神经蒂的横腹直肌肌皮瓣（TRAM瓣）进行即刻乳房重建。患者术后恢复过程顺利。转移时间在乳房重建后3个月至1年之间（平均5.8个月）。5例采用“四”字真皮瓣形成乳头凸起，3例采用圆形真皮瓣，1例采用双真皮瓣，1例采用去表皮滑行瓣。随访期为5至36个月（平均21.8个月）。所有移植均成功。乳头乳晕复合体适应性的最终评估中，4例为良好，4例为一般，2例为较差。苏木精-伊红染色的组织学检查显示乳头和乳晕皮肤无明显破坏，乳晕皮肤的电子显微镜检查未发现显著变化。然而，乳头皮肤的电子显微镜检查显示皮肤成分有严重损伤，包括桥粒延长、棘细胞层和基底层细胞间隙增宽以及棘细胞和基底细胞萎缩。尽管需要进一步改进冷冻过程和冷冻保存技术以防止乳头和乳晕色素脱失，但冷冻保存的乳头乳晕复合体转移至重建乳房可能是乳头乳晕重建的一种替代方法。
