Tomita Koichi, Yano Kenji, Taminato Mifue, Nomori Michiko, Hosokawa Ko
Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan.
Plast Reconstr Surg Glob Open. 2017 Oct 5;5(10):e1511. doi: 10.1097/GOX.0000000000001511. eCollection 2017 Oct.
Autologous breast reconstruction can be performed for breasts with ptosis to a certain extent, but if patients desire to correct ptosis, mastopexy of the contralateral breast is indicated. However, accurate prediction of post-mastopexy breast shape is difficult to make, and symmetrical breast reconstruction requires certain experience. We have previously reported the use of three-dimensional (3D) imaging and printing technologies in deep inferior epigastric artery perforator (DIEP) flap breast reconstruction. In the present study, these technologies were applied to the reconstruction of breasts with ptosis.
Eight breast cancer patients with ptotic breasts underwent two-stage unilateral DIEP flap breast reconstruction. In the initial surgery, tissue expander (TE) placement and contralateral mastopexy are performed simultaneously. Four to six months later, 3D bilateral breast imaging is performed after confirming that the shape of the contralateral breast (post-mastopexy) is somewhat stabilized, and a 3D-printed breast mold is created based on the mirror image of the shape of the contralateral breast acquired using analytical software. Then, DIEP flap surgery is performed, where the breast mold is used to determine the required flap volume and to shape the breast mound.
All flaps were engrafted without any major perioperative complications during both the initial and DIEP flap surgeries. Objective assessment of cosmetic outcome revealed that good breast symmetry was achieved in all cases.
The method described here may allow even inexperienced surgeons to achieve reconstruction of symmetrical, non-ptotic breasts with ease and in a short time. While the requirement of two surgeries is a potential disadvantage, our method will be particularly useful in cases involving TEs, i.e., delayed reconstruction or immediate reconstruction involving significant skin resection.
自体乳房重建在一定程度上可用于治疗乳房下垂的情况，但如果患者希望矫正下垂，对侧乳房的乳房上提术是必要的。然而，乳房上提术后乳房形状的准确预测很难做到，且对称乳房重建需要一定经验。我们之前报道过三维（3D）成像和打印技术在腹壁下动脉穿支（DIEP）皮瓣乳房重建中的应用。在本研究中，这些技术被应用于下垂乳房的重建。
8例乳房下垂的乳腺癌患者接受了两阶段单侧DIEP皮瓣乳房重建。在初次手术中，同时进行组织扩张器（TE）植入和对侧乳房上提术。4至6个月后，在确认对侧乳房（乳房上提术后）形状有所稳定后，进行双侧乳房3D成像，并基于使用分析软件获取的对侧乳房形状的镜像创建3D打印乳房模具。然后，进行DIEP皮瓣手术，使用乳房模具确定所需皮瓣体积并塑造乳房隆起。
在初次手术和DIEP皮瓣手术期间，所有皮瓣均成功植入，无任何重大围手术期并发症。对美容效果的客观评估显示，所有病例均实现了良好的乳房对称性。
本文所述方法可能使即使是经验不足的外科医生也能轻松且在短时间内实现对称、不下垂乳房的重建。虽然需要进行两次手术是一个潜在缺点，但我们的方法在涉及TE的情况下，即延迟重建或涉及大量皮肤切除的即刻重建中，将特别有用。
