Jeong Woo Shik, Han Wooyeon, Eom Jin Sup
Department of Plastic Surgery, Asan Medical Center, University of Ulsan, College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
Aesthetic Plast Surg. 2017 Feb;41(1):19-25. doi: 10.1007/s00266-016-0757-z. Epub 2016 Dec 28.
Tissue transfer, such as use of the transverse rectus abdominis myocutaneous (TRAM) or deep inferior epigastric artery perforator (DIEP) free flaps, is considered a standard method. However, outcomes may vary among inset methods. Here we compared the aesthetic outcomes of breast reconstructions using vertical and horizontal flap inset methods.
We, respectively, reviewed 274 patients who underwent unilateral post-mastectomy breast reconstruction using TRAM or DIEP free flaps between April 2006 and December 2013. Photographs (frontal and bilateral oblique views) obtained 6 months post-operatively were evaluated. Symmetry scores and regional volume discrepancy scores were compared between the vertical and horizontal inset groups. Symmetry scores were adjusted for 11 potential confounding factors on multivariate regression analysis.
The vertical inset method was associated with higher total symmetry scores, projection, and ptotic naturalness scores. On multivariate regression analysis, the inset method was an independent predictor of outcomes. Regional volume discrepancy score analysis showed a greater tendency for more symmetrical volumes in the upper, medial, and lateral poles with the vertical inset.
The flap inset method is one of the key determinants of aesthetic breast reconstruction outcomes. The vertical inset method was associated with superior aesthetic outcomes and enabled balanced distribution of flap volume to the four poles of the breast.
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组织移植，如使用腹直肌横形肌皮瓣（TRAM）或腹壁下动脉穿支（DIEP）游离皮瓣，被认为是一种标准方法。然而，不同的植入方法可能会导致不同的结果。在此，我们比较了采用垂直和水平皮瓣植入方法进行乳房重建的美学效果。
我们分别回顾了2006年4月至2013年12月期间接受TRAM或DIEP游离皮瓣单侧乳房切除术后重建的274例患者。对术后6个月获得的照片（正面和双侧斜视图）进行评估。比较垂直和水平植入组的对称性评分和区域体积差异评分。在多因素回归分析中，对对称性评分进行了11个潜在混杂因素的校正。
垂直植入方法与更高的总对称性评分、突出度和下垂自然度评分相关。在多因素回归分析中，植入方法是结果的独立预测因素。区域体积差异评分分析显示，垂直植入时，上、中、外侧象限的体积更趋于对称。
皮瓣植入方法是乳房美学重建效果的关键决定因素之一。垂直植入方法具有更好的美学效果，能够使皮瓣体积在乳房的四个象限中均匀分布。
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