Jensen Jay Arthur, Giuliano Armando E
Division of Plastic Surgery, Geffin School of Medicine at UCLA, Cedars-Sinai Medical Center, Los Angeles, Calif.
Division of Surgical Oncology, Cedars-Sinai Medical Center, Los Angeles, Calif.
Plast Reconstr Surg Glob Open. 2020 Jun 23;8(6):e2940. doi: 10.1097/GOX.0000000000002940. eCollection 2020 Jun.
Patients with macromastia or breast ptosis can undergo a nipple-sparing mastectomy if their mastectomy flaps are delayed or if they are subjected to a breast reduction procedure and later undergo mastectomy.
In this report, we describe a new technique to combine these two approaches by initially performing a subtotal mastectomy through a Wise keyhole incision in combination with the retention of the nipple -areolar complex on an inferior pedicle flap. A tissue expander and an allograft are routinely placed during this first stage. At a second stage, the inferior pedicle tissue is removed and submitted for pathological examination at the same time as the tissue expander is removed and replaced with a silicone or saline implant or autologous flap.
The Hybrid Delay procedure has been performed on three women (six breasts). Nipples were preserved in all patients. Final pathology did not reveal any cancer in the inferior pedicle preserved during the first procedure but removed and tested following the second.
By allowing the nipple to be safely transferred using the inferior pedicle flap, and then removing the inferior pedicle tissue during the subsequent reconstructive stage, women with macromastia and breast ptosis can be offered nipple-sparing mastectomy in the usual 2-stage reconstructive timing.
巨乳症或乳房下垂患者，如果其乳房切除皮瓣延迟或接受了乳房缩小手术，随后又进行乳房切除术，可接受保留乳头的乳房切除术。
在本报告中，我们描述了一种将这两种方法结合的新技术，即首先通过Wise锁孔切口进行次全乳房切除术，并将乳头乳晕复合体保留在一个下蒂皮瓣上。在第一阶段常规放置一个组织扩张器和一个同种异体移植物。在第二阶段，切除下蒂组织并送检病理，同时取出组织扩张器，并用硅胶或盐水植入物或自体皮瓣进行替换。
对三名女性（六个乳房）实施了混合延迟手术。所有患者的乳头均得以保留。最终病理检查显示，在第一次手术中保留但在第二次手术后切除并检测的下蒂组织中未发现任何癌症。
通过使用下蒂皮瓣安全转移乳头，然后在随后的重建阶段切除下蒂组织，巨乳症和乳房下垂的女性可以在常规的两阶段重建时机接受保留乳头的乳房切除术。
