Kümmel Sherko, Kümmel Aylin, Hagemann Friederike, Rüland Anna, Dittmer-Grabowski Christine, Botzenhardt Suzan, Blohmer Jens-Uwe, Reinisch Mattea
Breast Unit, Evangelische Huyssens-Stiftung, Kliniken Essen-Mitte, Essen, Germany.
Department of Obstetrics and Gynaecology, Breast Unit, Charité University Medicine, Campus Mitte and Benjamin Franklin, Berlin, Germany.
Breast Care (Basel). 2018 Oct;13(5):354-358. doi: 10.1159/000489939. Epub 2018 Aug 3.
One of the goals of breast cancer surgery is to preserve the breast. However, where this is not possible, various breast reconstructive procedures are available. The most common procedure is the immediate insertion of a subpectoral implant after removing the breast tissue. A significant challenge involving subpectoral implants is the deformation of the breast upon contraction of the pectoral muscle causing elevation of the breast and development of wrinkles or ripples in the caudal and cranial quadrants (jumping breast), especially in slim patients with a thin subcutaneous fat layer.
While the jumping breast phenomenon after augmentation is well-known in cosmetic breast surgery, it has never been systematically described. In oncologic breast surgery, this deformity, which at times can be quite severe, has been ignored thus far.
In this paper, we present an initial distinction of grades for the so-called jumping breast, show examples for the different grades of severity of breast deformity in response to tensing of the pectoral muscle, and further describe different primary and secondary procedures for the prevention of the jumping breast phenomenon. By means of a 2-stage procedure, we can prevent this complication and reduce the risk of breast deformity after implant-based breast reconstruction.
乳腺癌手术的目标之一是保留乳房。然而,若无法实现这一目标,则可采用多种乳房重建手术。最常见的手术是在切除乳房组织后立即植入胸肌下假体。涉及胸肌下假体的一个重大挑战是,胸肌收缩时乳房会变形,导致乳房抬高,并在乳房尾侧和头侧象限出现皱纹或波纹(乳房跳动),尤其是在皮下脂肪层较薄的瘦患者中。
虽然隆胸后乳房跳动现象在美容乳房手术中广为人知,但从未有过系统描述。在肿瘤性乳房手术中,这种有时可能相当严重的畸形至今一直被忽视。
在本文中,我们对所谓的乳房跳动进行了初步的分级区分,展示了胸肌紧张时不同严重程度乳房畸形的示例,并进一步描述了预防乳房跳动现象的不同的一期和二期手术方法。通过两阶段手术,我们可以预防这种并发症,并降低基于假体的乳房重建后乳房畸形的风险。