Demiri Efterpi C, Dionyssiou Dimitrios D, Tsimponis Antonios, Goula Christina-Olga, Pavlidis Leonidas C, Spyropoulou Georgia-Alexandra
Department of Plastic Surgery, Medical School, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Aesthetic Plast Surg. 2018 Jun;42(3):692-701. doi: 10.1007/s00266-018-1081-6. Epub 2018 Jan 25.
Although free abdominal flaps constitute the gold standard in post-radiation delayed breast reconstruction, latissimus dorsi-based methods offer alternative reconstructive options. This retrospective study aims to compare outcomes of delayed breast reconstruction using the fat-augmented latissimus dorsi (FALD) autologous reconstruction and the latissimus dorsi-plus-implant reconstruction in irradiated women.
We reviewed the files of 47 post-mastectomy irradiated patients (aged 29-73 years), who underwent delayed latissimus dorsi-based breast reconstruction between 2010 and 2016. Twenty-three patients (Group A) had an extended FALD flap and twenty-four patients (Group B) an implant-based latissimus dorsi reconstruction. Patients' age, BMI, pregnancies, volume of injected fat, implant size, postoperative complications, and secondary surgical procedures were recorded and analyzed.
Age, BMI, pregnancies, and donor-site complications were similar in both groups (p > 0.05). Mean fat volume injected initially was 254 cc (ranged 130-380 cc/session); mean implant volume was 323 cc (ranged 225-420 cc). Breast complications were significantly fewer in Group A (one wound dehiscence, two oily cysts) compared to Group B (three cases with wound dehiscence, two extrusions, thirteen severe capsular contractions). Non-statistically significant difference was documented for secondary procedures between groups; although the mean number of additional surgeries/patient was higher in Group A, they referred to secondary lipofilling, whereas in Group B they were revision surgeries for complications.
The FALD flap constitutes an alternative method for delayed autologous reconstruction after post-mastectomy irradiation, avoiding implant-related complications. Although additional fat graft sessions might be required, it provides an ideal autogenous reconstructive option for thin nulliparous women, with a small opposite breast and adequate fat donor sites.
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尽管游离腹部皮瓣是放疗后延迟乳房重建的金标准，但背阔肌肌皮瓣法提供了其他重建选择。这项回顾性研究旨在比较脂肪增强背阔肌（FALD）自体乳房重建和背阔肌肌皮瓣加假体乳房重建在接受过放疗的女性中的效果。
我们回顾了47例乳房切除术后接受放疗患者（年龄29 - 73岁）的病历，这些患者在2010年至2016年间接受了基于背阔肌肌皮瓣的延迟乳房重建。23例患者（A组）采用了改良的FALD皮瓣，24例患者（B组）采用了基于假体的背阔肌肌皮瓣重建。记录并分析患者的年龄、体重指数、妊娠次数、注射脂肪量、假体大小、术后并发症及二次手术情况。
两组患者的年龄、体重指数、妊娠次数及供区并发症相似（p > 0.05）。最初平均注射脂肪量为254 cc（每次范围130 - 380 cc）；平均假体体积为323 cc（范围225 - 420 cc）。与B组（3例伤口裂开、2例假体外露、13例严重包膜挛缩）相比，A组的乳房并发症明显更少（1例伤口裂开、2例油性囊肿）。两组二次手术情况无统计学显著差异；虽然A组每位患者额外手术的平均次数更高，但这些手术是二次脂肪填充，而B组的手术是针对并发症的修复手术。
FALD皮瓣是乳房切除术后放疗后延迟自体乳房重建的一种替代方法，可避免与假体相关的并发症。虽然可能需要额外的脂肪移植手术，但它为瘦的未生育女性、对侧乳房较小且有足够脂肪供区的患者提供了理想自体重建选择。
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