Rose Jessica F, Doval Andres F, Zavlin Dmitry, Ellsworth Warren A, Echo Anthony, Spiegel Aldona J
From the Division of Plastic and Reconstructive Surgery, University of Texas Health Science Center at Houston; and the Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine.
Plast Reconstr Surg. 2021 Jun 1;147(6):1271-1277. doi: 10.1097/PRS.0000000000007956.
Autologous free flap breast reconstruction is a common reconstructive procedure, with the ability to produce a natural breast shape and a long history of success. Despite its benefits, there are special situations in which patients lack sufficient donor-site tissue to achieve adequate breast size and projection. With this study, the authors describe their institutional experience of delayed implant augmentation after autologous breast reconstruction with a particular focus on pedicle division as a technique to improve aesthetic results.
A retrospective chart review of patients that underwent free flap autologous breast reconstruction with delayed implant augmentation was conducted over a 13-year period. Flaps were divided into a control group without pedicle division and a divided pedicle group. Groups were compared in terms of demographics, clinical and surgical characteristics, implant details, and postoperative implant and flap complications.
No significant differences in terms of age, body mass index, comorbidities, radiation therapy, or surgical indications were noted. The most common reason for delayed implant augmentation after autologous breast reconstruction was change in breast size and breast asymmetry. In terms of implant and flap complications, we found no significant differences between the control and divided pedicle groups after delayed implant augmentation.
From the authors' institutional experience, pedicle division in delayed breast augmentation with implants after free flap breast reconstruction can be safety performed in selected cases. This technique can be a powerful tool for plastic surgeons to improve the final aesthetic appearance of the reconstructed breast.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
自体游离皮瓣乳房重建是一种常见的重建手术，能够塑造自然的乳房形态，且长期以来效果良好。尽管有这些优点，但在某些特殊情况下，患者缺乏足够的供区组织来达到理想的乳房大小和凸度。在本研究中，作者描述了他们在自体乳房重建后延迟植入物隆乳方面的机构经验，特别关注将蒂部离断作为一种改善美学效果的技术。
对13年间接受游离皮瓣自体乳房重建并延迟植入物隆乳的患者进行回顾性病历审查。皮瓣分为未进行蒂部离断的对照组和蒂部离断组。比较两组患者的人口统计学、临床和手术特征、植入物细节以及术后植入物和皮瓣并发症。
在年龄、体重指数、合并症、放疗或手术指征方面未发现显著差异。自体乳房重建后延迟植入物隆乳最常见的原因是乳房大小改变和乳房不对称。在植入物和皮瓣并发症方面，我们发现在延迟植入物隆乳后，对照组和蒂部离断组之间没有显著差异。
根据作者的机构经验，在游离皮瓣乳房重建后延迟植入物隆乳时，在特定病例中可以安全地进行蒂部离断。该技术可以成为整形外科医生改善重建乳房最终美学外观的有力工具。
临床问题/证据级别：治疗性，III级。
