Petit J Y, Rigaut L, Gareer W, Michel G, Lehmann A
Eur J Surg Oncol. 1987 Jun;13(3):219-23.
Reconstruction of the breast (BR) after mastectomy without using a prosthetic implant has always presented a challenge for plastic surgeons, allowing them to avoid complications due to foreign body and to provide a more natural reconstructed breast. Out of 66 women who underwent BR using the rectus abdominis musculocutaneous flap, 52 received no implant. Ten upper rectus (ERF) and 42 lower rectus (TRAM) were the two procedures applied. The ERF has been abandoned due to the 9% rate of complete necrosis encountered among the total series of rectus flap regardless of the implant inclusion. Partial necrosis was also the most frequent complication of the TRAM (28% among those not having received an implant), but the reconstruction was nevertheless possible in all the cases. The TRAM technique produced abdominal sequelae in 45% of the no-implant cases, though it also improved the cosmetic aspect of the abdomen in an equal number of cases, particularly in obese women. Overall cosmetic results were also better for the TRAM without implant than for the ERF (72% good vs. 51%). Moreover the BR without implant could be performed in only 48% of the total ERF, as compared to 93% of the total TRAM. The major advantage of such BR without implant is that it provides a reconstructed breast which appears more symmetrical to the contralateral breast and which remains even after several years of follow-up.
在不使用假体植入物的情况下进行乳房切除术后的乳房重建（BR），一直是整形外科医生面临的一项挑战，这样能使他们避免因异物导致的并发症，并提供一个更自然的再造乳房。在66例使用腹直肌肌皮瓣进行乳房重建的女性中，52例未植入假体。应用了两种手术方法，即10例上腹部腹直肌肌皮瓣（ERF）和42例下腹部腹直肌肌皮瓣（TRAM）。由于在整个腹直肌皮瓣系列中，无论是否植入假体，均有9%的完全坏死率，因此ERF已被放弃。部分坏死也是TRAM最常见的并发症（在未接受植入物的患者中为28%），但在所有病例中仍可进行重建。TRAM技术在45%的未植入假体病例中产生了腹部后遗症，不过在相同数量的病例中，尤其是肥胖女性中，它也改善了腹部的外观。总体而言，未植入假体的TRAM的美容效果也优于ERF（良好率分别为72%和51%）。此外，未植入假体的乳房重建在全部ERF病例中仅能进行48%，而在全部TRAM病例中为93%。这种未植入假体的乳房重建的主要优点是，它提供的再造乳房与对侧乳房相比更对称，并且在数年的随访后仍然如此。
