Haddock Nicholas Till, Suszynski Thomas Mark, Teotia Sumeet Sorel
Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Tex.
Plast Reconstr Surg Glob Open. 2020 Apr 7;8(4):e2681. doi: 10.1097/GOX.0000000000002681. eCollection 2020 Apr.
Advances with newer perforator flaps and complex microsurgical techniques have enabled creative solutions in autologous breast reconstruction. For patients seeking total autologous breast reconstruction without the use of implants, body regions other than the abdomen have emerged to provide a substitute or additional donor tissue. In cases where abdominal perforator flaps are not possible (as with prior abdominoplasty), flaps taken from the lower back or thigh can be used. In situations of inadequate donor tissue in 1 body area, stacked multiple flap reconstruction is possible using donor tissue from multiple areas. In this article, we present our approach for individualizing treatment for breast reconstructive patients seeking to avoid permanent implants. We highlight how free perforator flap selection can not only serve to provide adequate tissue for body-appropriate breast reconstruction but may also be secondarily tailored to provide patient-specific aesthetic body contouring. Our preoperative patient counseling has evolved to involve flap selection based on clinical examination as well as advanced computed tomographic imaging of abdomen, thighs, and lower back. Decision to use 1 or more flaps is based on an assessment of whether the targeted body region(s) provide enough skin and fat for breast reconstruction, if the requisite perforator anatomy is available, and whether the effect of tissue procurement on their individualized aesthetic body contour is optimal.
新型穿支皮瓣和复杂显微外科技术的进展，为自体乳房重建提供了创新性的解决方案。对于那些寻求不使用植入物进行全自体乳房重建的患者，除腹部以外的身体部位已成为提供替代或额外供区组织的选择。在无法采用腹部穿支皮瓣的情况下（如既往有腹部整形手术史），可采用取自下背部或大腿的皮瓣。当一个身体区域的供区组织不足时，可使用来自多个区域的供区组织进行多层皮瓣堆叠重建。在本文中，我们介绍了针对寻求避免永久性植入物的乳房重建患者进行个体化治疗的方法。我们强调，游离穿支皮瓣的选择不仅可以为符合身体形态的乳房重建提供足够的组织，还可以进行二次调整，以实现针对患者的美学身体塑形。我们术前对患者的咨询已发展为基于临床检查以及对腹部、大腿和下背部的先进计算机断层扫描成像来选择皮瓣。决定使用一个或多个皮瓣是基于对目标身体区域是否能为乳房重建提供足够的皮肤和脂肪、是否有必要的穿支血管解剖结构以及组织获取对其个体化美学身体轮廓的影响是否最佳的评估。
