Dallas, Texas From the Department of Plastic Surgery, University of Texas Southwestern Medical Center.
Plast Reconstr Surg. 2011 Nov;128(5):1015-1024. doi: 10.1097/PRS.0b013e31821e6d2c.
Techniques in breast reconstruction have vastly improved with natural feeling, aesthetically pleasing breasts created through transfer of free or pedicled tissue. Traditional flap designs incorporate a skin paddle that leaves a "patch," which can be fairly large on the nouveau breast, clearly delineating the boundaries between the reconstruction and the native skin. In this article, the authors discuss the operative technique and present a clinical series of patients undergoing the periareolar advancement flap procedure. This technique reduces the skin paddle either to a circumferential areola-size area onto which the nipple can be simultaneously reconstructed (type I) or a single linear scar (type II) across the breast mound, thus enhancing the aesthetic appearance of the reconstructed breast.
A retrospective review of all patients between 2007 and 2009 undergoing periareolar advancement flaps under the care of the senior author (M.S.C.) was performed. Type of reconstruction, staging of procedures, additional operations, and complications were recorded.
Fifteen patients had a type I procedure and six patients had a type II procedure. There were no major complications. One patient had minor nipple scabbing that resolved. All type I patients had concomitant nipple reconstructions at the time of their periareolar advancement flap.
The periareolar advancement flap is a useful technique to include in the range of secondary revision procedures for further refinement of autologous breast reconstruction. It results in a sensate, more aesthetically pleasing breast. It has low complication rates and can be performed at the same time as a nipple reconstruction in type I patients.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
通过游离或带蒂组织的转移，创造出具有自然美感的乳房，使乳房再造技术得到了极大的改进。传统皮瓣设计包括一个皮瓣，在新乳房上留下一个“补丁”，这个补丁可能相当大，清楚地界定了重建和原生皮肤之间的边界。本文作者讨论了手术技术，并介绍了一组接受乳晕推进皮瓣手术的患者的临床系列。这种技术减少了皮瓣的大小，要么将其缩小到乳晕大小的环形区域，同时可以对乳头进行重建（I 型），要么在乳房丘上形成一条单一的线性疤痕（II 型），从而增强了重建乳房的美观。
对 2007 年至 2009 年间在高级作者（M.S.C.）的护理下接受乳晕推进皮瓣手术的所有患者进行了回顾性研究。记录了重建类型、手术分期、附加手术和并发症。
15 例患者行 I 型手术，6 例患者行 II 型手术。没有重大并发症。一例患者出现轻微的乳头结痂，已解决。所有 I 型患者在接受乳晕推进皮瓣的同时进行了乳头重建。
乳晕推进皮瓣是一种有用的技术，可以包括在自体乳房重建的二次修正程序中，以进一步完善。它能产生感觉良好、更美观的乳房。它具有较低的并发症发生率，可以与 I 型患者的乳头重建同时进行。
临床问题/证据水平：治疗，IV。
