Clerico C, Ihrai T, Raoust I, Chignon-Sicard B, Georgiou C, Flipo B
Centre Antoine-Lacassagne, Nice, France.
Ann Chir Plast Esthet. 2012 Dec;57(6):606-11. doi: 10.1016/j.anplas.2012.06.002. Epub 2012 Aug 4.
When performing mastectomy involving immediate reconstruction with prosthesis, it is required to obtain a complete cover of the implant. However, this is hardly ever possible for patients having a significant breast volume, despite the use of the skin-reducing technique. Using the lower dermal flap makes it possible to fully cover the implant for these patients.
We will describe five cases of patients on whom skin-reducing mastectomy and immediate reconstruction with prosthesis and lower dermal flap were performed. Preoperative drawings were made following the so-called "Saint-Louis" pattern. During surgery, the future skin flap representing the skin cover of lower breast quadrants was de-epidermised. Mastectomy was then performed via an incision at the upper limit of the future flap. Then, a retro-pectoral pocket was created by lifting the pectoralis major muscle. The implant was introduced into this pocket and covered up at its lower part by the dermal flap, the upper edge of which was sutured to the lower edge of the pectoralis major muscle. The implant was thereby fully covered. Finally, the skin was closed with inverted T-scars.
Postoperative effects were minor. Two patients suffered from skin pain at the junction between the vertical and horizontal scars of the inverted T. These injuries were treated via healing by secondary intention. We have not observed any infection. Cosmetic results assessed by the patients and surgical team were considered as satisfactory.
Mastectomy with immediate reconstruction using a prosthesis and lower dermal flap makes it possible to fully cover the implant in patients who require the skin-reducing technique. This technique seems to minimise the risk of major complications and generates satisfactory cosmetic results.
在进行乳房切除并即刻植入假体重建时，需要完全覆盖植入物。然而，对于乳房体积较大的患者，尽管采用了皮肤缩减技术，这几乎是不可能实现的。使用真皮下游离皮瓣能够为这些患者完全覆盖植入物。
我们将描述5例接受皮肤缩减乳房切除、即刻假体植入及真皮下游离皮瓣重建手术的患者。术前按照所谓的“圣路易”模式绘制图纸。手术过程中，对代表乳房下象限皮肤覆盖的未来皮瓣进行表皮剥脱。然后通过在未来皮瓣上缘的切口进行乳房切除。接着，通过提起胸大肌创建一个胸大肌后间隙。将植入物放入该间隙，并在其下部用真皮下游离皮瓣覆盖，皮瓣上缘缝合至胸大肌下缘。植入物由此得到完全覆盖。最后，采用倒T形切口缝合皮肤。
术后影响较小。2例患者在倒T形切口的垂直和水平瘢痕交界处出现皮肤疼痛。这些损伤通过二期愈合进行治疗。我们未观察到任何感染情况。患者和手术团队评估的美容效果令人满意。
采用假体及真皮下游离皮瓣进行即刻重建的乳房切除术能够为需要皮肤缩减技术的患者完全覆盖植入物。该技术似乎能将严重并发症的风险降至最低，并产生令人满意的美容效果。
