Tomita Koichi, Yano Kenji, Matsuda Ken, Takada Akiyoshi, Hosokawa Ko
Department of Plastic Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan.
Ann Plast Surg. 2008 Jul;61(1):19-23. doi: 10.1097/SAP.0b013e318156a1cf.
With the recent advances in oncologic breast surgery, breast reconstruction with the latissimus dorsi myocutaneous (LDM) flap without an implant has become a good option among other autologous tissue reconstructions available. However, only a few large-scale studies have so far evaluated the critical factors affecting its esthetic outcomes. We retrospectively reviewed 97 consecutive patients who underwent breast reconstruction with the LDM flap between 2001 and 2005 at our institution. The esthetic outcome in comparison with the normal breast was evaluated by means of observer assessment consisting of 7 criteria. A stratified analysis was performed to determine the factors affecting the esthetic outcomes after the breast-conservative surgery and skin-sparing mastectomy. We found that reconstruction of the lower half of the breast and exposure of the skin paddle resulted in poor esthetic outcomes after breast-conservative surgery. Large preoperative brassiere cup size, radiation history, axillary node dissection, and exposure of the skin paddle were the factors which negatively affected the overall outcomes after skin-sparing mastectomy. Age, body mass index, presence of nipple areola-complex defect, or design of skin paddle did not affect the esthetic outcomes. On the basis of these critical factors, we could determine the indications and limitations of breast reconstruction with LDM flap. In some cases, further technical modifications are still warranted, and we believe that these modifications will optimize the use of this flap in breast reconstruction.
随着近期肿瘤性乳房手术的进展，采用背阔肌肌皮（LDM）瓣且不植入假体的乳房重建已成为其他可用自体组织重建方法中的一个不错选择。然而，迄今为止，仅有少数大规模研究评估了影响其美学效果的关键因素。我们回顾性分析了2001年至2005年间在我院连续接受LDM瓣乳房重建的97例患者。通过由7项标准组成的观察者评估来评价与正常乳房相比的美学效果。进行分层分析以确定保乳手术和保留皮肤的乳房切除术后影响美学效果的因素。我们发现，保乳手术后乳房下半部的重建以及皮瓣外露导致美学效果不佳。术前胸罩罩杯尺寸大、有放疗史、腋窝淋巴结清扫以及皮瓣外露是影响保留皮肤的乳房切除术后总体效果的负面因素。年龄、体重指数、乳头乳晕复合体缺损的存在或皮瓣设计不影响美学效果。基于这些关键因素，我们能够确定LDM瓣乳房重建的适应证和局限性。在某些情况下，仍有必要进行进一步的技术改进，并且我们相信这些改进将优化该皮瓣在乳房重建中的应用。
