Kim Yang Woo, Kim Yoon Ji, Kong Jung Sik, Cheon Young Woo
Department of Plastic and Reconstructive Surgery, Gachon University Gil Medical Center, School of Medicine, Gachon University, 1198 Guwol-Dong, Namdong-Gu, Incheon, 405-760, Korea.
Aesthetic Plast Surg. 2014 Aug;38(4):704-10. doi: 10.1007/s00266-014-0351-1. Epub 2014 Jun 7.
Skin- or nipple-sparing mastectomy facilitates immediate one-stage reconstruction with an implant. Traditionally, an acellular dermal matrix or a muscle flap has been used because the inferolateral portion of the implant cannot be covered by the pectoralis major muscle. However, this method has drawbacks, including infection, cost, and donor-site morbidity. Therefore, we used an autologous conjoined fascial flap composed of the pectoralis major, serratus anterior, and external oblique fascia in patients with small-to-medium breasts.
A series of 11 immediate breast reconstructions in 11 patients was carried out from March 2010 to June 2011. The conjoined fascial flap and smooth round implants were used in all patients. Postoperative photographs were evaluated by a blinded panel and scored on a four-point scale. Patient satisfaction was evaluated by a postoperative questionnaire that had five items designed to evaluate quality of life with the reconstruction.
The mean body mass index was 23.2 kg/m(2), follow-up period was 30.9 months, and implant volume was 286.3 cc. Regarding complications, we observed one case of partial skin flap necrosis and one case of seroma accumulation in the axilla, both of which healed with conservative care. The mean overall breast satisfaction score was 3.18 ± 0.5.
The conjoined fascial flap is a viable alternative for immediate one-stage breast reconstruction with an implant. We recommend appropriate patient selection with a body mass index greater than 20 kg/m(2) and small-to-medium sized nonptotic breasts.
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保乳或保乳头乳房切除术有利于使用植入物进行一期即刻重建。传统上，由于植入物的下外侧部分无法被胸大肌覆盖，因此一直使用脱细胞真皮基质或肌瓣。然而，这种方法存在缺点，包括感染、成本和供区并发症。因此，我们在中、小乳房患者中使用了由胸大肌、前锯肌和腹外斜肌腱膜组成的自体联合筋膜瓣。
2010年3月至2011年6月，对11例患者进行了一系列11例即刻乳房重建手术。所有患者均使用联合筋膜瓣和平滑圆形植入物。由一组不知情的人员对术后照片进行评估，并采用四分制评分。通过一份术后问卷评估患者满意度，该问卷有五个项目，旨在评估重建后的生活质量。
平均体重指数为23.2kg/m²，随访期为30.9个月，植入物体积为286.3cc。关于并发症，我们观察到1例部分皮瓣坏死和1例腋窝血清肿积聚，两者均经保守治疗愈合。乳房总体满意度平均评分为3.18±0.5。
联合筋膜瓣是使用植入物进行一期即刻乳房重建的可行替代方法。我们建议选择体重指数大于20kg/m²且乳房为中小尺寸且不下垂的合适患者。
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