采用胸背动脉蒂脂肪筋膜瓣即刻体积置换对整形保乳术进行改良。
Modification of oncoplastic breast surgery with immediate volume replacement using a thoracodorsal adipofascial flap.
机构信息
Department of Breast Surgery, Fujita Health University, School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan.
Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan.
出版信息
Breast Cancer. 2022 May;29(3):531-540. doi: 10.1007/s12282-022-01331-7. Epub 2022 Feb 4.
BACKGROUND
The treatment of early breast cancer using breast conservation therapy (BCT) commonly ensures local control and acceptable cosmetic results. We report a useful technique including the use of a thoracodorsal adipofascial cutaneous flap for reconstructing defects in the outer quadrant area after partial mastectomy, which achieved excellent results.
METHODS
During the past 15 years, some modifications have been added to the original method at a rate of one modification every 2-5 years. We classified these modifications into the original method and four modified methods. Modification I: addition of a crescent-shaped dermis on the distant edge of the thoracodorsal adipofascial flap (TDAFF), Modification II: addition of a crescent-shaped dermis on the proximal edge of the TDAFF, Modification III: addition of inframammary formation plus Modification II, and Modification IV: change of a crescent-shaped dermis to a Benz-shaped (shaped like the Mercedes Benz logo) one plus Modification III. We compared the plastic period, postoperative complications, oncological results, and cosmetic results among the original and four modified groups.
RESULTS
The patient number was 26, 9, 15, 23, and 10 in the original and Modification I, II, III, and IV groups, respectively. The median observation period was 115, 92, 67, 51, and 32 months, respectively. Postoperative complications were seen in 5 (19%), 0, 2 (13%), 1 (5%), and 0 patients, respectively. Local recurrence was seen in 3 (12%), 0, 0, 0, and 0 patients, respectively. Distant recurrence was seen in 1 (4%), 1 (11%), 3 (20%), 0, and 0 patients, respectively. Cosmetic results evaluated as good-excellent were seen in 19 (73%), 5 (56%), 11 (73%), 19 (83%), and 10 (100%) patients, respectively.
CONCLUSIONS
Oncoplastic surgery using an immediate volume replacement technique with a thoracodorsal adipofascial flap was improved by adding some modifications.
背景
采用保乳治疗（BCT）治疗早期乳腺癌通常可确保局部控制和可接受的美容效果。我们报告了一种有用的技术，包括使用胸背脂肪筋膜皮瓣来修复部分乳房切除术后外象限区域的缺损，该技术取得了极好的效果。
方法
在过去的 15 年中，我们对原始方法进行了一些改进，每 2-5 年进行一次改进。我们将这些改进分为原始方法和四种改良方法。改良方法 I：在胸背脂肪筋膜皮瓣（TDAFF）的远端边缘添加一个新月形真皮，改良方法 II：在 TDAFF 的近端边缘添加一个新月形真皮，改良方法 III：添加乳晕下形成物和改良方法 II，改良方法 IV：将新月形真皮改为 Benz 形（类似于梅赛德斯-奔驰标志的形状），并添加改良方法 III。我们比较了原始组和改良组 I、II、III、IV 组的整形期、术后并发症、肿瘤学结果和美容效果。
结果
原始组和改良组 I、II、III、IV 组的患者人数分别为 26、9、15、23 和 10。中位观察期分别为 115、92、67、51 和 32 个月。术后并发症分别见于 5（19%）、0、2（13%）、1（5%）和 0 例患者。局部复发分别见于 3（12%）、0、0、0 和 0 例患者。远处复发分别见于 1（4%）、1（11%）、3（20%）、0 和 0 例患者。美容效果评价为良好-优秀的分别见于 19（73%）、5（56%）、11（73%）、19（83%）和 10（100%）例患者。
结论
采用胸背脂肪筋膜皮瓣即刻容积置换技术的肿瘤整形术通过添加一些改良得到了改善。
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