Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud, University of Rennes 1, 35200 Rennes, France.
Department of Plastic Surgery and Burn Surgery, Hopital Lapeyronie, Montpellier University Hospital, 34090 Montpellier, France.
Ann Chir Plast Esthet. 2020 Feb;65(1):44-53. doi: 10.1016/j.anplas.2019.07.006. Epub 2019 Jul 23.
After massive weight loss (MWL), female patients often develop upper trunk laxity and severe breast deformities. Usually several procedures are required to address upper body contouring issues.
To achieve better breasts and improve upper body contour, the authors employed a combined approach, associating lateral chest wall perforator propeller flaps with an upper bodylift (UBL).
Between September 2015 and March 2017, nine post-bariatric patients underwent simultaneously an UBL and autologous augmentation breast reshaping with lateral chest wall perforator propeller flaps. The authors analyzed the clinical indications, results and complications of this procedure.
Eighteen lateral perforator propeller flaps for autologous breast augmentation-mastopexy associated with an UBL were performed successfully. Mean pre-MWL body mass index (BMI) was 54.3±10.9kg/m, with a mean preoperative pre-UBL BMI of 28.7±3.6kg/m. The average weight loss before surgery was 67.7±22.4kg. The flaps were harvested on intercostal and/or lateral thoracic arteries. All donor sites had been closed primarily. Following the classification of Dindo and Clavien, four minor complications (I, II), and two major complications (IIIb), including two hematomas requiring reoperation, were reported. No flap necrosis occurred. Follow-up averaged 27.9±8.4months. The patients' satisfaction with their improved breast shapes and chest wall contours was "good", with an aesthetic outcome mean ranked 3.8±0.8 (out of 5).
After MWL, upper body deformities can be treated safely and reliably by a combined approach, associating an UBL and autologous lateral chest wall perforator flaps to provide more natural and durable breast shapes, as well as an upper circumferential reshaping.
大量体重减轻（MWL）后，女性患者常出现上躯干松弛和严重的乳房畸形。通常需要进行几次手术来解决上半身轮廓问题。
为了获得更好的乳房并改善上半身轮廓，作者采用了一种联合方法，将侧胸壁穿支螺旋桨皮瓣与上半身提升（UBL）结合使用。
在 2015 年 9 月至 2017 年 3 月期间，9 名减肥手术后的患者同时接受了 UBL 和自体隆胸的外侧胸壁穿支螺旋桨皮瓣成形术。作者分析了该手术的临床适应症、结果和并发症。
成功完成了 18 例与 UBL 相关的自体隆胸乳房提升术的外侧穿支螺旋桨皮瓣。术前 MWL 体重指数（BMI）平均为 54.3±10.9kg/m，术前 UBL BMI 平均为 28.7±3.6kg/m。手术前的平均减重为 67.7±22.4kg。皮瓣取自肋间和/或外侧胸动脉。所有供区均直接闭合。根据 Dindo 和 Clavien 的分类，报告了 4 例轻微并发症（I、II）和 2 例严重并发症（IIIb），包括 2 例需要再次手术的血肿。未发生皮瓣坏死。随访平均 27.9±8.4 个月。患者对改善后的乳房形状和胸壁轮廓的满意度为“良好”，美学效果平均评分为 3.8±0.8（满分 5 分）。
MWL 后，通过联合 UBL 和自体外侧胸壁穿支螺旋桨皮瓣的方法可以安全可靠地治疗上半身畸形，提供更自然和持久的乳房形状以及上半身轮廓重塑。
