Chae Michael P, Rozen Warren Matthew, Patel Nakul Gamanlal, Hunter-Smith David J, Ramakrishnan Venkat
Department of Surgery, School of Clinical Sciences at Monash Health, Monash Medical Centre, Clayton, Victoria, Australia.
Monash University Plastic and Reconstructive Surgery Group (Peninsula Clinical School), Peninsula Health, Frankston, Victoria, Australia.
Gland Surg. 2017 Dec;6(6):706-714. doi: 10.21037/gs.2017.06.01.
An increasing number of women undergo mastectomy for breast cancer and post-mastectomy autologous breast reconstruction has been shown to significantly improve the psychosexual wellbeing of the patients. A goal of treatment is to achieve symmetry and projection to match the native breast, and/or the contralateral breast in the case of a unilateral reconstruction. Autologous reconstruction, particularly with the deep inferior epigastric artery perforator (DIEP) flap, is particularly advantageous as it can be manipulated to mimic the shape and turgor of the native breast. However, very few techniques of shaping the breast conus when insetting the DIEP flap to enhance aesthetic outcome have been reported to date. With the aide of three-dimension (3D) photography and 3D-printed mirrored image of the contralateral breast as a guide intraoperatively, we describe our St Andrew's coning technique to create a personalized flap projection.
We report a prospective case series of 3 delayed unilateral breast reconstructions where symmetrization procedure to the contralateral breast was not indicated. Using a commercial 3D scanner (VECTRA XR, Canfield Scientific), the breast region was imaged. The mirrored image was 3D-printed in-house using a desktop 3D printer.
In all cases, projection of the breast mound was able to be safely achieved, with a demonstrated central volume (or 'cone') able to be highlighted on imaging and a 3D printed breast. A 3D print of the contralateral breast was able to be used intraoperatively to guide the operative approach.
The St Andrew's coning technique is a useful aesthetic maneuver for achieving breast projection during DIEP flap breast reconstruction, with 3D imaging techniques able to assist in perioperative assessment of breast volume.
越来越多的女性因乳腺癌接受乳房切除术，而乳房切除术后自体乳房重建已被证明能显著改善患者的心理性健康。治疗的一个目标是实现对称和突出，以匹配健侧乳房，对于单侧重建而言，则是匹配对侧乳房。自体重建，尤其是使用腹壁下深动脉穿支（DIEP）皮瓣，具有特别的优势，因为它可以被塑形以模仿健侧乳房的形状和弹性。然而，迄今为止，很少有关于在植入DIEP皮瓣时塑造乳房圆锥体以提高美学效果的技术报道。借助三维（3D）摄影和对侧乳房的3D打印镜像作为术中指导，我们描述了我们的圣安德鲁圆锥技术来创建个性化的皮瓣突出。
我们报告了一个前瞻性病例系列，包含3例延迟的单侧乳房重建，这些病例无需对对侧乳房进行对称化手术。使用商用3D扫描仪（VECTRA XR，Canfield Scientific）对乳房区域进行成像。镜像在内部使用桌面3D打印机进行3D打印。
在所有病例中，乳房隆起的突出都能够安全实现，成像和3D打印乳房上都能显示出突出的中央体积（或“圆锥体”）。对侧乳房的3D打印件能够在术中用于指导手术入路。
圣安德鲁圆锥技术是DIEP皮瓣乳房重建过程中实现乳房突出的一种有用的美学操作，3D成像技术能够辅助围手术期乳房体积评估。
