Kitcat Magelia, Molina Alexandra, Meldon Charlotte, Darhouse Nagham, Clibbon Jon, Malata Charles M
Department of Plastic and Reconstructive Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.
Eplasty. 2012;12:e55. Epub 2012 Dec 10.
Immediate small breast reconstruction poses challenges including limited potential donor site tissues, a thinner skin envelope, and limited implant choice. Few patients are suitable for autologous reconstruction while contralateral symmetrization surgery that often offsets the problem of obvious asymmetry in thin and small-breasted patients is often unavailable, too expensive, or declined by the patient.
We reviewed 42 consecutive patients with mastectomy weights of 350 g or less (the lowest quartile of all reconstructions). Indications for the mastectomy, body mass index, bra cup size, comorbidity, reconstruction type, and complications were recorded.
A total of 59 immediate reconstructions, including 25 latissimus dorsi flaps, 23 implant-only reconstructions, 9 abdominal flaps, and 2 gluteal flaps, were performed in 42 patients. Of the 42 mastectomies, 4 were prophylactic. Forty-three percent of patients had immediate contralateral balancing surgery. The average mastectomy weight was 231 g (range, 74-350 g). Seven percent of implant-based reconstructions developed capsular contracture requiring further surgery. One free transverse rectus abdominus myocutaneous flap failed because of fulminant methicillin resistant staphylococcus aureus septicaemia.
Balancing contralateral surgery is key in achieving excellent symmetry in reconstruction small-breasted patients. However, many patients wish to avoid contralateral surgery, thus restricting a surgeon's reconstructive options. Autologous flaps, traditionally, had not been considered in thinner women because of inadequacy of donor site tissue, but in fact, often, as with larger-breasted patients, produce superior cosmetic results. We propose a simple algorithm for the reconstruction of small-breasted women (without resorting to super-complex microsurgery), which is designed to tailor the choice of reconstructive technique to the requirements of the individual patient.
即刻小乳房重建面临诸多挑战，包括潜在供区组织有限、皮肤包膜较薄以及植入物选择受限。很少有患者适合自体组织重建，而对侧对称手术虽常能解决瘦小乳房患者明显不对称的问题，但往往无法实施、费用过高或患者拒绝接受。
我们回顾了连续42例乳房切除重量为350克或以下（所有重建手术中最低四分位数）的患者。记录了乳房切除术的指征、体重指数、胸罩罩杯尺寸、合并症、重建类型及并发症。
42例患者共进行了59例即刻重建手术，包括25例背阔肌肌皮瓣、23例单纯植入物重建、9例腹部皮瓣和2例臀大肌皮瓣。42例乳房切除术中，4例为预防性切除。43%的患者接受了即刻对侧平衡手术。乳房切除的平均重量为231克（范围74 - 350克）。7%的基于植入物的重建发生包膜挛缩，需要进一步手术。1例游离腹直肌肌皮瓣因暴发性耐甲氧西林金黄色葡萄球菌败血症而失败。
对侧平衡手术是实现瘦小乳房患者重建后极佳对称性的关键。然而，许多患者希望避免对侧手术，从而限制了外科医生的重建选择。传统上，由于供区组织不足，较瘦的女性未被考虑采用自体皮瓣，但实际上，与乳房较大的患者一样，自体皮瓣通常能产生更好的美容效果。我们提出了一种用于瘦小乳房女性重建的简单算法（无需借助超复杂的显微手术），旨在根据个体患者的需求来调整重建技术的选择。
