Hunter J E, Malata C M
Department of Plastic and Reconstructive Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Box 186, Hills Road, Cambridge CB2 2QQ, UK.
J Plast Reconstr Aesthet Surg. 2007;60(5):471-81. doi: 10.1016/j.bjps.2006.04.028. Epub 2006 Sep 29.
Skin-sparing mastectomy (SSM) is a well-established technique for immediate breast reconstruction (IBR). When used for large and/or ptotic breasts, traditional SSM patterns produce long skin flaps prone to necrosis or 'T' junction breakdown. The authors have previously demonstrated the applicability of the LeJour-type vertical mammaplasty skin pattern to this group of patients. With further experience, indications for this procedure have been widened and the technique refined.
Over five years, 26 immediate breast reconstructions were carried out in 19 patients using this technique: three expandable implants, seven LDs, three pedicled TRAMs, five free TRAMs, seven DIEPs and one SIEA flap. Fourteen patients (74%) had simultaneous contralateral balancing LeJour breast reductions or mastopexies. The remaining five patients had bilateral mastectomies and reconstructions using the vertical mammaplasty skin pattern for both breasts. All flaps were successful, but there were three cases of minor skin flap necrosis, three of delayed wound healing and two instances of significant post-operative bleeding. Cosmesis was suboptimal in the prosthetic reconstruction group, necessitating revisional surgery.
The vertical mammaplasty skin pattern was successfully used with a wide range of reconstructions. However, to avoid suboptimal cosmetic results and minimise wound healing problems this technique is not recommended in heavy smokers, very obese patients, those undergoing prosthetic reconstructions or neoadjuvant chemotherapy. The skin resection pattern should also be conservative. The LeJour-type vertical mammaplasty pattern is a viable alternative technique for SSM in selected patients, especially those requiring contralateral balancing surgery and undergoing autologous tissue reconstruction.
保留皮肤的乳房切除术（SSM）是一种成熟的即刻乳房重建（IBR）技术。当用于治疗体积较大和/或下垂的乳房时，传统的SSM术式会产生较长的皮瓣，容易出现坏死或“T”形切口裂开。作者之前已证明LeJour式垂直乳房成形术的皮肤切口模式适用于这类患者。随着经验的积累，该手术的适应证得以拓宽，技术也得到了改进。
在五年时间里，采用该技术对19例患者实施了26例即刻乳房重建手术：3例使用可扩张假体，7例使用背阔肌肌皮瓣，3例使用带蒂腹直肌肌皮瓣，5例使用游离腹直肌肌皮瓣，7例使用腹壁下动脉穿支皮瓣，1例使用腹壁浅动脉皮瓣。14例患者（74%）同时进行了对侧平衡的LeJour式乳房缩小术或乳房上提术。其余5例患者接受了双侧乳房切除术，并采用垂直乳房成形术的皮肤切口模式对双侧乳房进行重建。所有皮瓣均获成功，但有3例出现轻微皮瓣坏死，3例伤口愈合延迟，2例术后出现大量出血。假体重建组的美容效果欠佳，需要进行修复手术。
垂直乳房成形术的皮肤切口模式成功应用于多种重建手术。然而，为避免美容效果欠佳并尽量减少伤口愈合问题，不建议在重度吸烟者、极度肥胖患者、接受假体重建或新辅助化疗的患者中使用该技术。皮肤切除模式也应保守。对于特定患者，尤其是那些需要对侧平衡手术并接受自体组织重建的患者，LeJour式垂直乳房成形术模式是SSM的一种可行替代技术。
