Kim Ji Hun, Chun Yong Soon, Park Heung Kyu, Kim Sun Eung, Kim Yang Woo, Cheon Young Woo
From the Departments of Plastic and Reconstructive Surgery.
General Surgery, Gil Medical Center, Gachon University, College of Medicine, Incheon, Republic of Korea.
Ann Plast Surg. 2020 Nov;85(5):488-494. doi: 10.1097/SAP.0000000000002393.
Immediate breast reconstruction with implant (IBRI) can produce good aesthetic results after nipple-sparing mastectomy (NSM). Various surgical incisions can be used for NSM. The purpose of this study is to compare outcomes of using an IBRI with dual-coverage fascial flap after NSM with an inframammary fold (IMF) or a radial (Rd) incision.
We retrospectively reviewed the records of 88 women who underwent IBRI with dual-coverage fascial flap from March 2015 to June 2018. Inframammary fold incision was used in 19 patients (22 breasts) and Rd incision in 69 patients (75 breasts). In the dual-coverage method, acellular dermal matrix covered the inferomedial quadrant of the breast, and conjoined fascial flap covered the remaining inferolateral quadrant. Patient-reported satisfaction was assessed using the Breast-Q questionnaire, and plastic surgeons assessed aesthetic postoperative scores.
Complications and reoperation rates of 2 incisions were as follows: skin flap necrosis rate showed significant difference between 2 groups (IMF, 0.0% [0/22]; Rd, 16.0% [12/75]; P < 0.05). The other complication rates, hematoma, seroma, infection, capsular contracture, and total reoperations showed no significant difference. Postoperative Breast-Q scores were higher in the IMF group (331.9 ± 10.1) than in the Rd group (311.4 ± 11.0; P < 0.05), indicating higher satisfactory rate in the IMF group than in the Rd group. Surgeon-reported scores for breast symmetry, contour, and scar appearance were also higher in the IMF group (P < 0.05).
Immediate breast reconstruction with implant with dual-coverage fascial flap after NSM with IMF incision was associated with a lower rate of postoperative skin flap necrosis and improved patient satisfaction, compared with Rd incision. Inframammary fold incisions were associated with improved scar and breast appearance.
保留乳头的乳房切除术（NSM）后立即进行乳房植入物重建（IBRI）可产生良好的美学效果。NSM 可采用多种手术切口。本研究的目的是比较 NSM 后采用 IBRI 联合双覆盖筋膜瓣，经乳房下皱襞（IMF）或放射状（Rd）切口的效果。
我们回顾性分析了 2015 年 3 月至 2018 年 6 月期间 88 例行 IBRI 联合双覆盖筋膜瓣手术的女性患者的记录。19 例患者（22 侧乳房）采用乳房下皱襞切口，69 例患者（75 侧乳房）采用 Rd 切口。在双覆盖方法中，脱细胞真皮基质覆盖乳房的内下象限，联合筋膜瓣覆盖其余的外下象限。使用 Breast-Q 问卷评估患者报告的满意度，整形外科医生评估术后美学评分。
两种切口的并发症和再次手术率如下：皮瓣坏死率在两组间有显著差异（IMF，0.0%[0/22]；Rd，16.0%[12/75]；P<0.05）。其他并发症率，如血肿、血清肿、感染、包膜挛缩和总的再次手术率无显著差异。术后 Breast-Q 评分 IMF 组（331.9±10.1）高于 Rd 组（311.4±11.0；P<0.05），表明 IMF 组的满意度高于 Rd 组。整形外科医生报告的乳房对称性、轮廓和瘢痕外观评分 IMF 组也更高（P<0.05）。
与 Rd 切口相比，NSM 后采用 IMF 切口行 IBRI 联合双覆盖筋膜瓣，术后皮瓣坏死率较低，患者满意度提高。乳房下皱襞切口与改善瘢痕和乳房外观有关。
