Dixon J M, Venizelos B, Chan P
Edinburgh Breast Unit, Western General Hospital, Edinburgh, UK.
Breast. 2002 Feb;11(1):58-65. doi: 10.1054/brst.2001.0312.
The latissimus dorsi (LD) flap was first used in patients for breast reconstruction in 1896. More recently it has been used to fill defects after quadrantectomy or very wide excision. We have developed a two stage procedure for excision of large breast cancers which would otherwise require mastectomy. The first stage is a wide excision of the cancer without removal of the overlying skin. Thirty patients with large localized operable breast cancer underwent wide local excision followed 5 to 10 days later in 25 patients who had clear histological margins by an axillary dissection with transfer of the LD muscle and overlying fat into the defect in the breast (mini-flap). The cosmetic outcome of these 25 patients who underwent mini-flap were compared with age matched patients having a standard wide local excision and axillary node clearance or mastectomy and immediate breast reconstruction. The volume of tissue excised in patients having their defects filled by LD mini-flap was significantly greater than those women undergoing standard wide excision, p<0.001. Compared with patients who had a mastectomy and immediate breast reconstruction, patients who had mini-flaps reported a better treated breast shape, p=0.04, a greater resemblance to the opposite breast, less self consciousness and less change in attitude of their spouse, p=0.03 and they were more likely to choose the same operation in future compared with patients having immediate whole breast reconstruction, p=0.02. Results as rated by patients in the mini-flap group were similar to those women treated by standard wide local excision. Only one patient in the mini-flap group felt sexually inhibited. When wide local excision and LD mini-flap is performed as a two stage procedure, it is an oncologically safe technique and extends breast conservation to women with larger tumours. The cosmetic outcomes appear better than those following the alternative of mastectomy and immediate breast reconstruction.
1896年，背阔肌（LD）皮瓣首次用于患者的乳房重建。最近，它被用于象限切除或非常广泛切除后的缺损填充。我们开发了一种两阶段手术方法，用于切除原本需要乳房切除术的大型乳腺癌。第一阶段是广泛切除癌症，而不切除覆盖的皮肤。30例患有大型局限性可手术乳腺癌的患者接受了广泛局部切除，5至10天后，25例组织学切缘清晰的患者进行了腋窝清扫，并将背阔肌及其上方的脂肪转移至乳房缺损处（微型皮瓣）。将这25例行微型皮瓣手术患者的美容效果与年龄匹配的接受标准广泛局部切除和腋窝淋巴结清扫或乳房切除及即刻乳房重建的患者进行比较。接受LD微型皮瓣填充缺损患者切除的组织量明显大于接受标准广泛切除的女性，p<0.001。与接受乳房切除及即刻乳房重建的患者相比，接受微型皮瓣手术的患者报告其治疗后的乳房形状更好，p=0.04，与对侧乳房更相似，自我意识更低，配偶态度变化更小，p=0.03，与接受即刻全乳重建的患者相比，他们未来更有可能选择相同的手术，p=0.02。微型皮瓣组患者的评分结果与接受标准广泛局部切除治疗的女性相似。微型皮瓣组只有1例患者感到性抑制。当将广泛局部切除和LD微型皮瓣作为两阶段手术进行时，这是一种肿瘤学上安全的技术，可将保乳治疗扩展至患有较大肿瘤的女性。其美容效果似乎优于乳房切除及即刻乳房重建的替代方案。
