Kijima Yuko, Yoshinaka Heiji, Owaki Tetsuhiro, Aikou Takashi
Department of Surgical Oncology, Breast and Endocrine Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan.
J Plast Reconstr Aesthet Surg. 2007;60(5):495-502. doi: 10.1016/j.bjps.2006.06.004. Epub 2006 Sep 6.
Breast conservational therapy (BCT) has become a standard strategy for breast cancer, and ensures that local control with acceptable cosmetic results [Fisher B, Anderson S, Redmond CK, et al. Reanalysis and results after 12 years of follow-up in a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med 1995;333:1456-61] and immediate reconstruction after BCT has become increasingly popular even for early-stage breast cancer [Berrino P, Campora E, Santi P. Post-quadrantectomy breast deformities: classification and techniques of surgical correction. Plast Reconstr Surg 1987;79(4):567-72; Cooperman AM, Dinner M. The rhomboid flap and partial mastectomy. Surg Clin North Am 1978;58:869-73]. The breasts of Japanese women are sometimes too small to maintain symmetry, even after partial resection, and an insufficient resection margin may increase local recurrence if too much attention is paid to cosmesis. Use of an autologous free dermal fat graft (FDFG) for defect reconstruction has proven popular for some areas of the body [Lexer E. Free transplantation. Ann Surg 1914;60:166-94; Peer LA. The neglected free fat graft. Plast Reconstr Surg 1956;18:233-50]. Immediate reconstruction of the surgical defect was performed in seven Japanese women using autologous free dermal fat graft (FDFG) from the lower abdomen after breast-conserving surgeries for six malignant lesions and two benign masses located in the medial or central area of the breasts. The mean amount of resected tissue was 56.4 g (range, 28-108 g), while mean FDFG weight was 78.3g (range, 35-148 g). We obtained symmetry in the size of the whole breast, the position and level of the nipple, and shape. Autologous FDFG was useful for reconstruction, with a good cosmetic effect. This technique achieves better cosmetic results than the transposition of residual breast tissue, is more convenient than muscle flap grafting, and safer than implantation of foreign materials. This report documents our early experiences with seven patients who underwent BCT and immediate breast reconstruction using autologous FDFG.
保乳治疗（BCT）已成为乳腺癌的标准治疗策略，并确保在获得可接受的美容效果的同时实现局部控制[费希尔B、安德森S、雷德蒙德CK等。一项比较全乳切除术与保乳手术加或不加放疗治疗乳腺癌的随机临床试验12年随访后的重新分析及结果。《新英格兰医学杂志》1995年；333:1456 - 61]，并且保乳治疗后的即刻乳房重建即使对于早期乳腺癌也越来越普遍[贝里诺P、坎波拉E、桑蒂P。象限切除术后乳房畸形：手术矫正的分类和技术。《整形与重建外科》1987年；79(4):567 - 72；库珀曼AM、迪纳M。菱形皮瓣与部分乳房切除术。《北美外科临床》1978年；58:869 - 73]。日本女性的乳房有时过小，即使部分切除后也难以保持对称，而且如果过于注重美容效果，切除边缘不足可能会增加局部复发风险。自体游离真皮脂肪移植（FDFG）用于缺损重建在身体某些部位已被证明很受欢迎[莱克瑟E。游离移植。《外科学年鉴》1914年；60:166 - 94；皮尔LA。被忽视的游离脂肪移植。《整形与重建外科》1956年；18:233 - 50]。对位于乳房内侧或中央区域的6个恶性病变和2个良性肿块进行保乳手术后，使用来自下腹部的自体游离真皮脂肪移植（FDFG）对7名日本女性的手术缺损进行了即刻重建。切除组织的平均重量为56.4克（范围为28 - 108克），而FDFG的平均重量为78.3克（范围为35 - 148克）。我们实现了整个乳房大小、乳头位置和高度以及形状的对称。自体FDFG对重建很有用，美容效果良好。该技术比残留乳腺组织移位术能获得更好的美容效果，比肌皮瓣移植更方便，比植入异物更安全。本报告记录了我们对7例接受保乳治疗并使用自体FDFG进行即刻乳房重建患者的早期经验。
