Nava Maurizio B, Cortinovis Umberto, Ottolenghi Joseph, Riggio Egidio, Pennati Angela, Catanuto Giuseppe, Greco Marco, Rovere Guidubaldo Querci Della
Plastic and Reconstructive Surgery Unit, Istituto Nazionale Tumori, Milan, Italy.
Plast Reconstr Surg. 2006 Sep;118(3):603-10; discussion 611-3. doi: 10.1097/01.prs.0000233024.08392.14.
The authors propose a combined flap technique to reconstruct large and medium-sized ptotic breasts in a single-stage operation by use of anatomical permanent implants.
The authors enrolled 28 patients fulfilling criteria for skin-sparing mastectomy and presenting with ptotic breasts whose areola-to-inframammary fold distance was more than 8 cm. All reconstructions were performed as a single-stage procedure. After preoperative planning, a large area in the lower half of the breast was deepithelialized according to the conventional Wise pattern. Mastectomy was then carried out. To perform reconstructions, the inferomedial fibers of the pectoralis major muscle were dissected and sutured to the superior border of the inferior dermal flap. An anatomical implant was then inserted into the pouch, which was closed laterally with the previously harvested serratus anterior fascia. Skin flaps were finally closed down to the inframammary fold.
The authors performed 30 procedures on 28 patients. The medium size anatomical implants was 433 cc. Twelve women achieved symmetrization in a single stage ending in a symmetric inverted-T scar. The overall complication rate was 20 percent, with four cases (13 percent) complicated by severe, extensive necrosis of the skin flaps requiring implant removal.
Breast cancer treatment must nowadays optimize cosmetic results. This can be accomplished in selected cases by means of a single-stage operation that the authors call "skin-reducing mastectomy." The final scars imitate those of cosmetic surgery. Careful patient selection and improvement in the learning curve may reduce the complication rate.
作者提出一种联合皮瓣技术，通过使用解剖型永久性植入物在一期手术中重建大中型下垂乳房。
作者纳入了28例符合保留皮肤乳房切除术标准且存在乳晕至乳房下皱襞距离超过8 cm的下垂乳房患者。所有重建均作为一期手术进行。术前规划后，按照传统的 Wise 模式对乳房下半部的大片区域进行去上皮化。然后进行乳房切除术。为了进行重建，解剖胸大肌的下内侧纤维并缝合至下方皮瓣的上缘。然后将解剖型植入物插入囊袋，囊袋外侧用先前切取的前锯肌筋膜封闭。最后将皮瓣向下缝合至乳房下皱襞。
作者对28例患者进行了30次手术。中等尺寸的解剖型植入物为433 cc。12名女性在一期手术中实现了对称，最终形成对称的倒T形瘢痕。总体并发症发生率为20%，4例（13%）出现严重、广泛的皮瓣坏死，需要取出植入物。
如今乳腺癌治疗必须优化美容效果。在特定病例中，可以通过作者称为“皮肤缩减乳房切除术”的一期手术来实现。最终瘢痕类似于整形手术的瘢痕。仔细的患者选择和学习曲线的改善可能会降低并发症发生率。
