Goldman Boris E, Capasse Jeanne S, McGregor Andrew, H M Cheng Zandra
Aesthetic Plastic Surgery Center LLC, Westport, Connecticut.
Western Connecticut Health Network, Norwalk, Connecticut.
Plast Reconstr Surg Glob Open. 2019 Dec 31;7(12):e2392. doi: 10.1097/GOX.0000000000002392. eCollection 2019 Dec.
Autologous breast reconstruction historically required flaps that were invasive, required prolonged operative times and recoveries, and resulted in varying degrees of donor site morbidity. We present our early results with a minimally invasive completely autologous breast reconstruction technique utilizing buried dermato-cutaneous (DMC) flaps and immediate fat grafting. A 25-patient, 43-breast consecutive case series is presented.
Select patients desiring autologous breast reconstruction who had sufficient breast ptosis and fat donor tissue were offered breast reconstruction with buried folded over DMC flaps with adipocyte transfer (DCAT). A Wise pattern mastectomy was performed, and fat was transferred into an inferiorly based, buried and folded DMC flap. Fat was also immediately grafted into the pectoralis, subpectoral space, and below pectoralis and serratus fascia. Most patients underwent additional fat grafting at 3-month intervals to complete the reconstruction.
Twenty-five consecutive patients (43 breasts) underwent the DCAT procedure with 18 (42%) free nipple grafts. Eight patients (8 breasts) had prior breast radiation, and 2 patients (2 breasts) required postmastectomy radiation. Average fat grafted at initial mastectomy was 70 mL per breast (range 50-103 mL). Nineteen patients (76%) underwent additional outpatient fat grafting. Two additional outpatient fat graft sessions (range 0-3) at 3-month intervals completed the reconstruction. Average fat grafted at the second stage was 217 mL (range 50-320 mL). Average follow-up was 20 months from DCAT and 12 months from last fat graft.
The DCAT procedure appears to provide a minimally invasive, autologous breast reconstruction alternative in select patients.
从历史上看，自体乳房重建需要采用具有侵入性的皮瓣，手术时间长，恢复时间久，且供区会出现不同程度的并发症。我们展示了使用埋置式皮肤-皮下组织（DMC）皮瓣和即时脂肪移植的微创完全自体乳房重建技术的早期结果。本文呈现了一个包含25例患者、43侧乳房的连续病例系列。
为那些希望进行自体乳房重建、有足够乳房下垂程度和脂肪供区组织的特定患者提供采用带脂肪细胞转移的埋置折叠DMC皮瓣（DCAT）进行乳房重建。行改良根治性乳房切除术，将脂肪转移至以下方为基底、埋置并折叠的DMC皮瓣中。脂肪也即时移植到胸大肌、胸大肌下间隙以及胸大肌和前锯肌筋膜下方。大多数患者每隔3个月进行额外的脂肪移植以完成重建。
25例连续患者（43侧乳房）接受了DCAT手术，其中18例（42%）进行了游离乳头移植。8例患者（8侧乳房）曾接受过乳房放疗，2例患者（2侧乳房）在乳房切除术后需要放疗。初次乳房切除时平均每侧乳房移植脂肪70 mL（范围为50 - 103 mL）。19例患者（76%）接受了额外的门诊脂肪移植。每隔3个月进行另外2次门诊脂肪移植（范围为0 - 3次）以完成重建。第二阶段平均移植脂肪217 mL（范围为50 - 320 mL）。从DCAT手术开始平均随访20个月，从最后一次脂肪移植开始平均随访12个月。
DCAT手术似乎为特定患者提供了一种微创的自体乳房重建选择。
