Fujiwara Takashi, Yano Kenji, Tanji Yoshio, Nomura Masaya
Department of Plastic Surgery, Morinomiya Hospital, Osaka, Japan; Department of Plastic Surgery, Osaka Breast Clinic, Osaka, Japan; and Department of Breast and Endocrine Surgery, Morinomiya Hospital, Osaka, Japan.
Plast Reconstr Surg Glob Open. 2018 Mar 13;6(3):e1717. doi: 10.1097/GOX.0000000000001717. eCollection 2018 Mar.
Breast-conserving therapy, where radiotherapy is performed after partial mastectomy, is a widely used surgical method that can preserve most of the breast tissue without increasing the recurrence rate of breast cancer. However, without reconstruction, asymmetry of the breast occurs due to the tissue defect and radiation fibrosis, producing in poor cosmetic results. In this case study, we performed staged prosthetic breast reconstruction combined with fat grafting for severe depressive deformation of the breast after breast-conserving therapy. The first surgery involved insertion of a tissue expander and fat grafting, second surgery was the reduction of injected saline volume and fat grafting, and third surgery involved exchange for an implant and fat grafting. The skin in the depressed area, which had atrophied, became soft and flexible; deformation was also improved, and the patient was satisfied with the aesthetic outcome. It is expected that fat grafting will fertilize and qualitatively improve the damaged tissue due to irradiation, reducing the complications related to the tissue expander and implant. We believe that it will be possible to correct a breast deformity after breast-conserving therapy using a tissue expander and implant, which had not been considered as a solution. The results showed that the present method can be an option for delayed reconstruction after breast-conserving therapy.
保乳治疗是一种广泛应用的手术方法，即在部分乳房切除术后进行放疗，该方法能够保留大部分乳腺组织，且不会增加乳腺癌的复发率。然而，如果不进行乳房重建，由于组织缺损和放射性纤维化，乳房会出现不对称，导致美容效果不佳。在本病例研究中，我们对保乳治疗后乳房严重凹陷变形的患者进行了分期假体乳房重建联合脂肪移植。第一次手术包括植入组织扩张器和脂肪移植，第二次手术是减少注入的盐水量并进行脂肪移植，第三次手术是更换为植入物并进行脂肪移植。凹陷区域萎缩的皮肤变得柔软且有弹性；变形也得到改善，患者对美学效果感到满意。预计脂肪移植将滋养并定性改善因放疗受损的组织，减少与组织扩张器和植入物相关的并发症。我们认为，使用组织扩张器和植入物来纠正保乳治疗后的乳房畸形将成为可能，而这之前并未被视为一种解决方案。结果表明，本方法可作为保乳治疗后延迟重建的一种选择。
