Dec Wojciech
Department of Plastic Surgery, Lenox Hill Hospital, New York, N.Y.
Plast Reconstr Surg Glob Open. 2017 Aug 9;5(8):e1447. doi: 10.1097/GOX.0000000000001447. eCollection 2017 Aug.
The need to restore both the missing breast volume and breast surface area makes achieving excellent aesthetic outcomes in delayed breast reconstruction especially challenging. Autologous breast reconstruction can be used to achieve both goals. The aim of this study was to identify surgical maneuvers that can optimize aesthetic outcomes in delayed breast reconstruction.
This is a retrospective review of operative and clinical records of all patients who underwent unilateral or bilateral delayed breast reconstruction with autologous tissue between April 2014 and January 2017. Three groups of delayed breast reconstruction patients were identified based on patient characteristics.
A total of 26 flaps were successfully performed in 17 patients. Key surgical maneuvers for achieving aesthetically optimal results were identified. A statistically significant difference for volume requirements was identified in cases where a delayed breast reconstruction and a contralateral immediate breast reconstruction were performed simultaneously.
Optimal aesthetic results can be achieved with: (1) restoration of breast skin envelope with tissue expansion when possible, (2) optimal positioning of a small skin paddle to be later incorporated entirely into a nipple areola reconstruction when adequate breast skin surface area is present, (3) limiting the reconstructed breast mound to 2 skin tones when large area skin resurfacing is required, (4) increasing breast volume by deepithelializing, not discarding, the inferior mastectomy flap skin, (5) eccentric division of abdominal flaps when an immediate and delayed bilateral breast reconstructions are performed simultaneously; and (6) performing second-stage breast reconstruction revisions and fat grafting.
恢复缺失的乳房体积和乳房表面积的需求使得在延迟乳房重建中实现出色的美学效果尤其具有挑战性。自体乳房重建可用于实现这两个目标。本研究的目的是确定能够优化延迟乳房重建美学效果的手术操作。
这是一项对2014年4月至2017年1月期间所有接受单侧或双侧自体组织延迟乳房重建患者的手术和临床记录的回顾性研究。根据患者特征确定了三组延迟乳房重建患者。
17例患者共成功实施了26个皮瓣手术。确定了实现美学最佳效果的关键手术操作。在同时进行延迟乳房重建和对侧即刻乳房重建的病例中，确定了体积需求的统计学显著差异。
通过以下方法可实现最佳美学效果：（1）尽可能通过组织扩张恢复乳房皮肤包膜；（2）当有足够的乳房皮肤表面积时，将小皮肤瓣最佳定位，以便随后完全纳入乳头乳晕重建；（3）当需要大面积皮肤重新覆盖时，将重建的乳房隆起限制在2个肤色范围内；（4）通过保留乳房下切除皮瓣皮肤的上皮，而不是丢弃它，来增加乳房体积；（5）当同时进行即刻和延迟双侧乳房重建时，对腹部皮瓣进行偏心分割；以及（6）进行二期乳房重建修复和脂肪移植。
