Rezaei Ezatollah, Pouryousef Kamrooz, Karimi Mohammad, Hajebi Khaniki Saeedeh, Baradaran Sirjani Ehsan
Department of Plastic Surgery, Endoscopic and Minimally Invasive Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran.
World J Plast Surg. 2019 Sep;8(3):394-400. doi: 10.29252/wjps.8.3.394.
Breast reconstruction is distinct among plastic surgery techniques. This study analysed the results of breast reconstruction with the Latissimus dorsi (LD) myocutaneous flap as a strategy for better coverage and positioning of the implant.
Twenty patients who underwent surgery between September 2013 and September 2016 were enrolled. Fourteen patients underwent reconstruction with LD and tissue expander (TE) exchanged later with implant. Six patients were reconstructed with LD and implant. The complications, problems, and aesthetic improvement associated with the use of implants placed under LD muscle were assessed.
0ne case required an expander removal because of deflation of TE, also one case had seroma formation due to recurrence of breast cancer and also one case had seroma in donor site. No asymmetry was detected in the inframammary fold (IMF) position between reconstructed and normal regions. After the procedure, 80% of the patients reported that their expectations were met, 95% reported no functional limitations, and 5% reported mild limitations that ameliorated with physiotherapy. The placement of implants (prostheses or expanders) under the muscle with using the LD muscle flap to cover the implant improved the breast contour by softening the inframammary crease and positioning the implants in the upper and medial quadrants of the new breasts.
Breast reconstruction using silicone implants and the LD muscle flap can have excellent outcomes with low rates of complications. Placing the implant under a layer of muscle improved the harmony of the upper quadrants during breast reconstruction.
乳房重建在整形外科技术中独具特色。本研究分析了背阔肌（LD）肌皮瓣乳房重建的结果，以此作为更好地覆盖和定位植入物的一种策略。
纳入2013年9月至2016年9月期间接受手术的20例患者。14例患者采用LD联合组织扩张器（TE）进行重建，之后再更换为植入物。6例患者采用LD联合植入物进行重建。评估了与在LD肌下放置植入物相关的并发症、问题及美学改善情况。
1例因TE瘪陷而需要取出扩张器，1例因乳腺癌复发出现血清肿，还有1例供区出现血清肿。重建区域与正常区域之间的乳房下皱襞（IMF）位置未检测到不对称。术后，80%的患者表示达到了预期，95%的患者表示无功能受限，5%的患者表示有轻度受限，但经物理治疗后有所改善。利用LD肌皮瓣覆盖植入物，将植入物（假体或扩张器）放置在肌肉下，通过软化乳房下皱襞并将植入物定位在新乳房的上内侧象限，改善了乳房轮廓。
使用硅胶植入物和LD肌皮瓣进行乳房重建可取得良好效果，并发症发生率较低。在乳房重建过程中，将植入物放置在一层肌肉下可改善上象限的协调性。
