Huang Jung-Ju, Wu Chih-Wei, Leon Lam Wee, Lin Chia-Yu, Nguyen Dung H, Cheng Ming-Huei
Division of Reconstructive microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Ann Plast Surg. 2011 Oct;67(4):336-42. doi: 10.1097/SAP.0b013e31820859c5.
Successful breast reconstruction includes the creation of a natural breast mound in addition to achieving maximal symmetry of both breasts. This study investigated the patients' outcome and satisfaction of simultaneous contralateral balancing reduction/mastopexy with unilateral breast reconstruction using free abdominal flaps.
Between March 2000 and September 2009, 22 of 288 patients underwent unilateral breast reconstructions using a free abdominal flap with simultaneous contralateral breast reduction/mastopexy (group A). The remaining 266 cases were used as the control group (group B). The ultimate cosmesis with the complete pre- and postoperative pictures was assessed. The survey for the quality of life using the Heden questionnaire was obtained from 16 patients in group A.
All 22 flaps survived. Two deep inferior epigastric artery perforator flaps developed venous congestion and subsequent partial flap loss. The mean flap-used weight was 568 ± 128.6 g and 486 ± 158 g in group A and B, respectively (P < 0.01). There were no complications resulted from the reduction/mastopexy. The mean reduced breast tissue was 173.6 ± 101 g (range, 85-355 g). The overall cosmetic scores in group A were higher than in the group B. Of 16 patients, 7 (43.8%) graded this technique as very advantageous and the remaining 9 patients (56.2%) as advantageous.
Simultaneous contralateral balancing procedures including reduction/mastopexy in selected patients can be performed with unilateral breast reconstruction using free abdominal flaps with greater patient satisfaction, minimal increase in operative time, and no increase in complication rates.
成功的乳房重建不仅包括塑造自然的乳房隆起，还需实现双侧乳房的最大程度对称。本研究调查了采用游离腹直肌皮瓣进行单侧乳房重建同时行对侧平衡缩乳/乳房上提术患者的治疗效果及满意度。
2000年3月至2009年9月期间，288例患者中有22例采用游离腹直肌皮瓣进行单侧乳房重建并同期行对侧乳房缩乳/乳房上提术（A组）。其余266例作为对照组（B组）。通过完整的术前和术后照片评估最终的美容效果。采用赫登问卷对A组16例患者进行生活质量调查。
所有22块皮瓣均存活。2块腹壁下动脉穿支皮瓣出现静脉淤血，随后部分皮瓣坏死。A组和B组皮瓣平均使用重量分别为568±128.6 g和486±158 g（P<0.01）。缩乳/乳房上提术未引发并发症。平均切除的乳房组织为173.6±101 g（范围85 - 355 g）。A组的总体美容评分高于B组。16例患者中，7例（43.8%）认为该技术非常有利，其余9例（56.2%）认为有利。
对于部分患者，在采用游离腹直肌皮瓣进行单侧乳房重建的同时行包括缩乳/乳房上提术在内的对侧平衡手术，可使患者满意度更高，手术时间增加极少，且并发症发生率无增加。
