Giudice Giuseppe, Maruccia Michele, Nacchiero Eleonora, Elia Rossella, Annoscia Paolo, Vestita Michelangelo
Section of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari, 11, Piazza Giulio Cesare, Bari, 70124, Italy.
JPRAS Open. 2018 Jan 31;15:74-80. doi: 10.1016/j.jpra.2017.11.003. eCollection 2018 Mar.
Women who were good candidates for a skin reducing mastectomy, but were instead treated with a skin-sparing mastectomy and reconstruction with expanders, show discrepancy of volume and form between the healthy breast (voluminous and ptotic) and the expanded mastectomy envelope and muscle, which has a smaller size as well as excessive amount of skin at the lower pole.
From January 2014 to March 2015, we recruited 18 women with breasts of medium to large volume and with moderate to severe ptosis, already treated at a different centre with a one-side mastectomy and reconstruction by means of an expander. These women were treated at our unit for the second reconstructive step with a dual plane technique and a contralateral reduction/mastopexy.
The minimum duration of follow-up was 2 years (range 24-30 months). The average volume of the implants was 613 g. The reconstructive outcome at the final follow-up (at least 24 months) was judged by the specialist as excellent in 5 cases, very good in 10 cases and good in 3 cases. Breast Q average score was 87.08.
The disinsertion of the expanded muscle dome and the use of a dual plane technique for the placement of the definitive implant provide a solution to the skin-volume mismatch problem. The subcutaneous placement of the implant at the level of the lower pole extends the excessive amount of skin and gives the reconstructed breast fullness and natural ptosis. Further validation of our results is needed.
对于那些适合进行皮肤缩减乳房切除术的女性，若采用保留皮肤的乳房切除术并使用扩张器进行重建，会出现健康乳房（丰满且下垂）与扩张后的乳房包膜及肌肉之间的体积和形态差异，后者尺寸较小且下极皮肤过多。
2014年1月至2015年3月，我们招募了18名乳房体积为中到大且有中度至重度下垂的女性，她们已在其他中心接受过一侧乳房切除术并使用扩张器进行重建。这些女性在我们科室接受二期重建手术，采用双平面技术和对侧乳房缩小/上提术。
最短随访时间为2年（范围24 - 30个月）。植入物的平均体积为613克。专科医生在最终随访（至少24个月）时判定重建效果为：5例优秀，10例非常好，3例良好。乳房Q平均评分为87.08。
扩张肌肉穹顶的分离以及使用双平面技术放置最终植入物为皮肤 - 体积不匹配问题提供了解决方案。在下极水平皮下放置植入物可延展过多的皮肤，并使重建乳房丰满且自然下垂。我们的结果需要进一步验证。
