Petit J Y, Barreau-Pouaher L, Le M, Lehmann A, Rietjens M
Département de Chirurgie Générale et Carcinologique, Institut Gustave-Roussy, Villejuif.
Ann Chir Plast Esthet. 1992 Dec;37(6):701-8.
Based on a series of 516 patients operated between 1976 and 1991, the authors present their experience of the various aspects of immediate breast reconstruction (IBR). A prosthesis was used in the majority of cases (80%) and the essential technical aspect was the creation of a complete muscular compartment, possibly by combining pectoralis major and serratus anterior, latissimus dorsi (5%) and by using an expander (8%) or even a musculocutaneous flap. The rectus abdominis musculocutaneous flap (TRAM, 10%) had the advantage of allowing IBR without a prosthesis. The mastectomy scar plays a major role in determining the final shape of the breast: the skin resection must be modulated according to the site of the tumour. The complications observed (40%), which required removal of the prosthesis in 12% of cases, were either immediate complications (20%), some of which (infections, necrosis, dehiscence) tended to delay adjuvant therapy, or secondary complications, principally grade III-IV contracture (20%). Evaluation of the cosmetic results of IBR in comparison with a population undergoing secondary reconstruction over the same period, did not reveal any significant difference between the two approaches. The authors discuss in detail the oncological and technical arguments for and against IBR and conclude on the psychological advantages of IBR for mastectomised patients.
基于1976年至1991年间接受手术的516例患者，作者介绍了他们在即刻乳房重建（IBR）各个方面的经验。大多数病例（80%）使用了假体，关键技术要点是创建一个完整的肌肉腔隙，可能通过联合胸大肌和前锯肌、背阔肌（5%），以及使用扩张器（8%）甚至肌皮瓣来实现。腹直肌肌皮瓣（横行腹直肌肌皮瓣，TRAM，10%）具有无需假体即可进行即刻乳房重建的优势。乳房切除瘢痕在决定乳房最终形态方面起着重要作用：皮肤切除必须根据肿瘤部位进行调整。观察到的并发症发生率为40%，其中12%的病例需要取出假体，这些并发症要么是即刻并发症（20%），其中一些（感染、坏死、裂开）往往会延迟辅助治疗，要么是继发并发症，主要是III-IV级挛缩（20%）。与同期接受二期重建的人群相比，对即刻乳房重建的美容效果进行评估，结果显示两种方法之间没有显著差异。作者详细讨论了支持和反对即刻乳房重建的肿瘤学和技术论据，并得出即刻乳房重建对乳房切除患者具有心理优势的结论。
