Fodor L, Bota I O, Filip C I, Grecea D, Fodor M, Dindelegan G, Motocu R, Ciuce C
Department of Plastic Surgery and Burn Unit, Emergency District Hospital, Cluj Napoca, Romania.
Chirurgia (Bucur). 2011 Jul-Aug;106(4):485-9.
Breast reconstruction (BR) after radical mastectomy is intended to recreate symmetrical natural-appearing breasts while preserving patient safety and quality of life.
To evaluate the esthetic results and the complications of various BR methods after radical mastectomy.
Between August 2006 and March 2010, 36 women underwent BR after mastectomy in our institution. Their charts were reviewed retrospectively to evaluate the results and complications. We used immediate BR for Stage I and IIa breast carcinoma, and delayed BR for stage IIb and III breast carcinoma.
We performed a pedicled Transverse Rectus Abdominis Muscle flap in 13 cases, pedicled Latissimus Dorsi with silicone implant in 10 cases, free Deep Inferior Epigastric Perforator (DIEP) flap in 9 cases, and other procedures in four cases. The encountered complications were: total flap failure--one case, partial edge flap necrosis--three cases, donor area wound dehiscence--one case, seroma--one case, local infection--one case.
Trends in BR in recent years focus more on free perforator flaps, with the DIEP flap being the leader. Internal mammary vessels are most often used as recipient vessels for anasthomoses. Immediate BR when indicated has better aesthetic results. In less well-developed countries, insurance companies do not cover implant expenses and the autologous procedures remain the best option.
根治性乳房切除术后的乳房重建旨在再造外观对称自然的乳房，同时确保患者安全和生活质量。
评估根治性乳房切除术后各种乳房重建方法的美学效果和并发症。
2006年8月至2010年3月期间，我院36例女性患者在乳房切除术后接受了乳房重建。对她们的病历进行回顾性分析，以评估手术效果和并发症情况。对于Ⅰ期和Ⅱa期乳腺癌患者，我们采用即刻乳房重建；对于Ⅱb期和Ⅲ期乳腺癌患者，则采用延迟乳房重建。
我们采用了带蒂腹直肌肌皮瓣13例、带蒂背阔肌肌皮瓣联合硅胶假体10例、游离腹壁下深动脉穿支（DIEP）皮瓣9例以及其他手术方式4例。所遇到的并发症包括：皮瓣完全坏死1例、皮瓣边缘部分坏死3例、供区伤口裂开1例、血清肿1例、局部感染1例。
近年来乳房重建的趋势更多地集中在游离穿支皮瓣，其中DIEP皮瓣处于领先地位。胸廓内血管最常被用作吻合的受区血管。在有指征时进行即刻乳房重建可获得更好的美学效果。在欠发达国家，保险公司不承担假体费用，自体组织手术仍然是最佳选择。
