Youssif Sherif, Hassan Youssef, Tohamy Ahmed, Eid Samir, Ashour Tarek, Malahias Marco, Khalil Haitham
Plastic and Reconstructive Surgery Division, Good Hope Hospital, University Hospitals Birmingham NHS Trust, Birmingham, UK.
Plastic Surgery Department, Faculty of Medicine, Assiut University Hospitals, Assiut, Egypt.
Gland Surg. 2019 Oct;8(5):527-536. doi: 10.21037/gs.2019.09.06.
Breast conserving surgery (BCS) followed by radiotherapy has gained great popularity in the treatment of breast cancer over the past years. However, radiation therapy can lead to many unfavourable aesthetic outcomes including significant volume/skin deficiency, nipple areola complex distortion and skin contraction. We present our experience in using pedicled perforator flaps to tackle the resultant partial breast defects or deformities.
A retrospective data analysis study on Thirty patients with post breast conserving surgery (BCS) partial breast defects who were managed with pedicled per-forator flaps including muscle sparing latissimus dorsi muscle flap (MSLD), thoraco-dorsal artery perforator flap (TDAP) and intercostal artery perforator flap (ICAP) in the period between December 2008 and December 2018.
Defects were in all quadrants apart from the upper inner quadrant. The reconstructive techniques included TDAP flap 6/30 (20%), MSLD flap 20/30 (66.7%), AICAP flap 4/30 (13.3%). Age ranges 22-35 (mean 29). All flaps showed complete survival, one nipple areola complex superficial epidermolysis was experienced, and one patient presented with fat necrosis. No resultant donor site morbidity apart from scar revision for excess skin at the axillary fold in one patient. The overall satisfaction reached 94% with only 8 patients who required lipofilling to maximize the cosmetic outcome.
The availability of a range of reliable techniques including thoracodorsal/intercostal artery perforator flap (TAP/ICAP) and muscle sparing lattissimus dorsi flap (MSLD) allow optimum results to be achieved in the treatment of partial breast defects following breast conserving surgery.
在过去几年中，保乳手术（BCS）联合放射治疗在乳腺癌治疗中广受欢迎。然而，放射治疗会导致许多不良美学后果，包括明显的体积/皮肤缺损、乳头乳晕复合体变形和皮肤收缩。我们介绍了使用带蒂穿支皮瓣处理由此产生的部分乳房缺损或畸形的经验。
对2008年12月至2018年12月期间30例保乳手术后出现部分乳房缺损并采用带蒂穿支皮瓣治疗的患者进行回顾性数据分析研究，这些皮瓣包括保留肌肉的背阔肌皮瓣（MSLD）、胸背动脉穿支皮瓣（TDAP）和肋间动脉穿支皮瓣（ICAP）。
除上内象限外，各象限均有缺损。重建技术包括TDAP皮瓣6/30（20%）、MSLD皮瓣20/30（66.7%）、AICAP皮瓣4/30（13.3%）。年龄范围为22 - 35岁（平均29岁）。所有皮瓣均完全存活，1例出现乳头乳晕复合体浅表表皮松解，1例患者出现脂肪坏死。除1例患者因腋窝皱襞处皮肤过多需进行瘢痕修整外，未出现供区并发症。总体满意度达到94%，只有8例患者需要脂肪填充以优化美容效果。
一系列可靠技术的应用，包括胸背/肋间动脉穿支皮瓣（TAP/ICAP）和保留肌肉的背阔肌皮瓣（MSLD），能够在保乳手术后部分乳房缺损的治疗中取得最佳效果。
