Ganandran Thevarasan, Redit Ragnild, Mat Johar Fatimah, Wan Sulaiman Wan Azman, Halim Ahmad Sukari
Reconstructive Sciences Unit, Universiti Sains Malaysia, Kubang Kerian, MYS.
Cureus. 2022 Mar 16;14(3):e23230. doi: 10.7759/cureus.23230. eCollection 2022 Mar.
The reverse abdominoplasty technique has uses that extend past cosmetic surgery into the field of reconstructive surgery. With a thorough understanding of the technique and modifications, this method may be used to cover extensive chest wall defects post-mastectomy in select patients. Reconstructive algorithms for locally advanced breast cancer tend to favor microsurgical techniques. However, the surgeon needs to choose the optimal reconstructive option based on the defect size, disease stage, future oncological therapeutic approach, and patients' general condition. Patients with aggressive forms of breast cancer have higher risks of recurrence despite advances in chemotherapy. This subset of patients may be poor responders to adjuvant or neoadjuvant oncological drugs, may require postoperative radiotherapy, or be at high risk for early recurrence. In this subset of patients, we advocate the use of a reverse abdominoplasty for immediate autologous soft tissue coverage of the chest wall after breast cancer resection. It provides a robust soft tissue cover for radiotherapy and spares potential future autologous donor sites for delayed breast reconstruction while facilitating early clinical detection of recurrence. Here, we discuss a case treated with this technique and explore the surgical technique, pitfalls, and advantages of this technique with the outcome that validates decision-making.
腹壁成形术的反向技术的应用范围已从整形手术扩展到重建手术领域。通过对该技术及其改良方法的深入理解，这种方法可用于为特定患者在乳房切除术后覆盖大面积胸壁缺损。局部晚期乳腺癌的重建方案往往倾向于显微外科技术。然而，外科医生需要根据缺损大小、疾病分期、未来肿瘤治疗方法以及患者的一般状况来选择最佳的重建方案。尽管化疗有所进展，但侵袭性乳腺癌患者的复发风险更高。这部分患者可能对辅助或新辅助肿瘤药物反应不佳，可能需要术后放疗，或早期复发风险较高。在这部分患者中，我们提倡在乳腺癌切除术后立即使用反向腹壁成形术进行自体软组织覆盖胸壁。它为放疗提供了坚固的软组织覆盖，保留了未来用于延迟乳房重建的潜在自体供区，同时便于早期临床发现复发。在此，我们讨论一例采用该技术治疗的病例，并探讨该技术的手术技巧、陷阱和优势，其结果验证了决策的合理性。
