Dec Wojciech
Department of Plastic Surgery, Lenox Hill Hospital, 100 East 77th Street, New York, NY, USA.
JPRAS Open. 2018 Feb 14;16:24-30. doi: 10.1016/j.jpra.2018.01.005. eCollection 2018 Jun.
Achieving excellent aesthetic outcomes in reconstruction of large or ptotic breasts is especially challenging. Incorporating a Wise pattern into the mastectomy design is effective in reducing the excess breast skin, however it increases the risk of mastectomy skin necrosis. The aim of this study is to describe surgical maneuvers which optimize aesthetic outcomes, anticipate flap volume requirements, and limit mastectomy skin necrosis in autologous reconstruction in patients with macromastia and grade III ptosis.
This is a retrospective review of operative and clinical records of patients who underwent unilateral or bilateral breast reconstruction with autologous tissue between August 2015 and May 2017. Patients were divided into macromastia and ptosis groups. Key surgical maneuvers for safely achieving aesthetically optimal results were identified.
A total of 29 breasts were successfully reconstructed in 19 patients with a Wise pattern mastectomy skin reduction. Free flap weights were similar in both groups, mastectomy weights were greater in the macromastia group, p < 0.05. Complications were limited to three cases of wound breakdown and one case of mastectomy skin necrosis. Total number of revision stages was reduced in unilateral reconstructions when a contralateral breast reduction or mastopexy was performed during the first stage.
A Wise pattern can safely and effectively be incorporated into a mastectomy incision design in patients who are not candidates for a nipple sparing mastectomy. Optimal aesthetics are achieved with similar volume flaps for both macromastia and ptosis patients. In cases of unilateral breast reconstruction a contralateral breast reduction or mastopexy should be performed at the time of the immediate breast reconstruction.
在大型或下垂乳房的重建中实现出色的美学效果尤其具有挑战性。在乳房切除术设计中纳入 Wise 模式可有效减少多余的乳房皮肤，然而这会增加乳房切除术后皮肤坏死的风险。本研究的目的是描述手术操作，这些操作可优化美学效果、预估皮瓣体积需求并限制巨乳症和Ⅲ度下垂患者自体乳房重建中乳房切除术后皮肤坏死的发生。
这是一项对 2015 年 8 月至 2017 年 5 月间接受自体组织单侧或双侧乳房重建患者的手术及临床记录的回顾性研究。患者被分为巨乳症组和乳房下垂组。确定了安全实现美学最佳效果的关键手术操作。
19 例患者共 29 个乳房通过 Wise 模式乳房切除皮肤缩减术成功重建。两组游离皮瓣重量相似，巨乳症组乳房切除重量更大，p < 0.05。并发症仅限于 3 例伤口裂开和 1 例乳房切除术后皮肤坏死。当在第一阶段进行对侧乳房缩小术或乳房固定术时，单侧重建的翻修阶段总数减少。
对于不适合保留乳头乳房切除术的患者，Wise 模式可安全有效地纳入乳房切除术切口设计。巨乳症和乳房下垂患者使用相似体积的皮瓣可实现最佳美学效果。在单侧乳房重建的情况下，应在即刻乳房重建时进行对侧乳房缩小术或乳房固定术。
