Dong Jiasheng, Wang Tao, Zhang Yi, Xu Hua, He Jinguang
a Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai JiaoTong University School of Medicine , Shanghai , P. R. China.
J Plast Surg Hand Surg. 2019 Aug;53(4):204-207. doi: 10.1080/2000656X.2019.1582423. Epub 2019 Mar 14.
In the setting of secondary breast reconstruction by deep inferior epigastric artery perforator (DIEP) flap, the mastectomy skin is usually deepithelialized and buried under the reconstructed breast. In this study, by virtue of tube flap technique, we hypothesize that an amount of mastectomy skin could be transferred to the apex of reconstructed breast mound for nipple reconstruction. A total of 30 female postmastectomy patients were recruited between June 2012 and August 2015. A bipedicle DIEP flap was harvested and folded upward to reconstruct the breast. An inferiorly based mastectomy flap was raised and rolled into a tube. The free end of the flap was sutured to the reconstructed breast mound to allow revascularization. After serial stages, a sufficient tissue bulk from the mastectomy flap was transferred to the apex of the breast mound and remolded into a new nipple. Reconstructed breasts and nipples survived well postoperatively. The mean nipple projection was 9.2 ± 2.7 mm at the 1-year follow-up. In total 24 patients ranked the overall nipple and breast reconstruction to be very good or good. Based on DIEP flap breast reconstruction, the staged immediate nipple reconstruction with local mastectomy tube flap could maintain a long term residual projection with aesthetically acceptable outcomes.
在采用腹壁下深动脉穿支（DIEP）皮瓣进行二期乳房重建的情况下，乳房切除术后的皮肤通常会进行去上皮化处理，并埋置于重建乳房之下。在本研究中，借助皮管皮瓣技术，我们推测一定量的乳房切除术后皮肤可转移至重建乳房隆起的顶端用于乳头重建。2012年6月至2015年8月期间共招募了30例乳房切除术后的女性患者。切取双蒂DIEP皮瓣并向上折叠以重建乳房。掀起一个以下方为蒂的乳房切除皮瓣并卷成皮管。将皮瓣的游离端缝合至重建乳房隆起处，使其重新血管化。经过连续几个阶段，将来自乳房切除皮瓣的足够组织量转移至乳房隆起的顶端，并重塑成一个新乳头。重建的乳房和乳头术后存活良好。在1年随访时，乳头平均突出度为9.2±2.7毫米。共有24例患者将整体乳头和乳房重建评价为非常好或良好。基于DIEP皮瓣乳房重建，采用局部乳房切除皮管皮瓣进行分期即刻乳头重建可维持长期的残余突出度，且美学效果可接受。
