Lipa Joan E, Addison Patrick D, Neligan Peter C
Division of Plastic Surgery and Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Ontario.
Can J Plast Surg. 2008 Summer;16(2):85-8. doi: 10.1177/229255030801600207.
Nipple-areolar reconstruction completes post-mastectomy breast reconstruction. Many techniques for nipple reconstruction have been described, and each has their advocates and critics. One of the frequent failings of most designs is loss of nipple projection with time.
To determine the effect of including autologous costal cartilage on patient satisfaction with their nipple reconstruction.
Sixty-eight patients were identified who had undergone fishtail flap nipple reconstruction following autologous free flap breast reconstruction between 1990 and 2004. Qualitative questionnaires, using Likert scales, were sent to each patient to specifically assess their satisfaction with their nipple reconstruction.
Of 26 respondents (mean +/- SEM follow-up period 3.7+/-3.6 years), 13 had undergone nipple reconstruction incorporating costal cartilage banked at the time of initial breast reconstruction, and the other 13 had no cartilage in their nipple reconstructions. While both groups would opt for nipple reconstruction again, patients with cartilage grafts incorporated into their reconstructions had overall satisfaction ratings 1.92 grades higher on average (not significant, P=0.12) than those without. This difference increased to 3.2 grades when the satisfaction of the patient's partner was taken into account (P<0.05). Improved satisfaction corresponded to higher scores for volume, consistency, texture, and particularly for projection and contour of the nipple (P<0.05). Although nipple morphology changed over time, there was a trend toward improved stability in the cartilage group.
Patient satisfaction with nipple reconstruction can be improved by incorporating costal cartilage beneath the skin flaps. Superior contour and projection are sustained over time.
乳头乳晕重建完善了乳房切除术后的乳房重建。已经描述了许多乳头重建技术，每种技术都有其支持者和批评者。大多数设计常见的一个缺点是乳头突出度会随着时间的推移而丧失。
确定采用自体肋软骨对患者乳头重建满意度的影响。
确定了68例在1990年至2004年间接受自体游离皮瓣乳房重建术后采用鱼尾皮瓣乳头重建的患者。使用李克特量表的定性问卷被发送给每位患者，以专门评估他们对乳头重建的满意度。
在26名受访者中（平均±标准误随访期3.7±3.6年），13例在初次乳房重建时采用了储存的肋软骨进行乳头重建，另外13例在乳头重建中未使用软骨。虽然两组患者都愿意再次进行乳头重建，但在重建中采用软骨移植的患者总体满意度评分平均比未采用的患者高1.92级（无显著性差异，P = 0.12）。当考虑患者伴侣的满意度时，这种差异增加到3.2级（P < 0.05）。满意度的提高对应于体积、质地、纹理方面的更高评分，特别是乳头的突出度和轮廓方面（P < 0.05）。虽然乳头形态随时间发生了变化，但软骨组有稳定性改善的趋势。
通过在皮瓣下植入肋软骨可以提高患者对乳头重建的满意度。随着时间的推移，乳头的轮廓和突出度得以保持。
