Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 33 Badachu Road, Shijingshan District, Beijing, 100144, China.
Beijing ALEO Clinic of Aesthetic Surgery, Beijing, China.
Aesthetic Plast Surg. 2019 Oct;43(5):1186-1194. doi: 10.1007/s00266-019-01346-0. Epub 2019 Mar 14.
Breast hypoplasia or amastia with pectoralis major muscle defect in female Poland syndrome patients always necessitates surgical intervention. This study aims to introduce an efficient endoscopic technique to perform breast reconstruction in Poland syndrome patients with a latissimus dorsi myo flap and an implant using a single transverse axillary incision (ELDM + IMPLANT) and to evaluate its safety and effectiveness.
A prospective study was designed to recruit Poland syndrome candidates for ELDM + IMPLANT breast reconstruction. Only one transaxillary incision was made to harvest the LDM flap and create the anterior chest wall pocket. The LDM flap was transposed to the front to reconstruct the breast with a silicone implant. Patient demographics, LDM area, implant size, contralateral symmetry surgery, operative time and post-operative complications were collected. The BREAST-Q reconstruction module was used to evaluate patient quality of life. The disabilities of the arm, shoulder and hand (DASH) outcome questionnaire was used to evaluate patient upper extremity disabilities.
Sixteen eligible patients were recruited and received ELDM + IMPLANT-BR. Mean endoscopic time for LDM flap harvesting was 61.6 min. All of the 16 patients recovered uneventfully without any significant complications. The post-operative scores of satisfaction with breast and psychosocial well-being were significantly higher than the pre-operative ones. The score of DASH was 7.1 pre-operatively and 8.3 post-operatively with no significant difference either. The score of satisfaction with outcome was 80.0.
Our proposed ELDM + IMPLANT technique provides a safe and efficient way to reconstruct breasts in Poland syndrome patients with a high satisfaction rate, optimized aesthetic outcome and minimized donor site morbidity.
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波兰综合征女性患者的乳房发育不全或缺失伴胸大肌缺陷通常需要手术干预。本研究旨在介绍一种有效的内镜技术，通过使用背阔肌肌皮瓣和植入物进行乳房重建（ELDM+植入物），治疗波兰综合征患者，并评估其安全性和有效性。
本前瞻性研究设计招募了波兰综合征候选患者进行 ELDM+植入物乳房重建。仅采用单一的横腋窝切口完成 LDM 皮瓣的获取和前胸壁袋的制作。将 LDM 皮瓣转移到前方，用硅胶植入物重建乳房。收集患者的人口统计学资料、LDM 面积、植入物大小、对侧对称手术、手术时间和术后并发症。采用 BREAST-Q 重建模块评估患者生活质量。采用残疾的胳膊、肩和手（DASH）问卷评估患者上肢残疾情况。
共纳入 16 例符合条件的患者接受 ELDM+植入物乳房重建。LDM 皮瓣采集的平均内镜时间为 61.6 分钟。16 例患者均顺利康复，无明显并发症。术后乳房满意度和心理社会幸福感评分显著高于术前。DASH 术前评分为 7.1 分，术后评分为 8.3 分，差异无统计学意义。满意度评分为 80.0。
我们提出的 ELDM+植入物技术为波兰综合征患者提供了一种安全有效的乳房重建方法，具有较高的满意度、优化的美学效果和最小化的供区并发症。
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