Jinan University, Guangzhou, 510000, China.
Mammary Gland, Maoming People's Hospital, Maoming, 525000, China.
BMC Surg. 2023 Feb 21;23(1):41. doi: 10.1186/s12893-023-01937-4.
Volume replacement is one of the vital techniques of oncoplastic surgery (OPS) when applying breast-conserving surgery. The clinical application of peri-mammary artery perforator flaps for this indication is uneven in China. Here, we describe the results of our clinical experience with peri-mammary artery flaps for partial breast reconstruction.
In this study, 30 patients underwent partial breast resection for quadrant breast cancer followed by partial breast reconstruction with peri-mammary artery perforator flaps, which included the thoracodorsal artery perforator flap (TDAP), anterior intercostal artery perforator flap (AICAP), lateral intercostal artery perforator flap (LICAP), and lateral thoracic artery perforator flap (LTAP). All the patients' operation plans were discussed comprehensively and were performed by sticking to every step. The satisfaction outcome was assessed with the extracted version of the BREAST-Q version 2.0, Breast Conserving Therapy Module Preoperative and Postoperative Scales both preoperatively and postoperatively.
According to the study outcomes, the mean flap size was 5.34.22.8 cm (3.0-7.03.0-5.01.0-3.5 cm). The mean surgical time was 142 min (100-250 min). No partial flap failure was detected, and no severe complications were observed. Most patients were satisfied with the outcomes regarding the dressing, sexual life, and breast shape postoperation. Furthermore, the sensation of the surgical area, scar satisfaction, and recovery state gradually improved. Overall, LICAP and AICAP had higher scores when different flaps were compared.
Based on this study, we found that peri-mammary artery flaps had significant value in breast-conserving surgery, especially in patients with small or medium-sized breasts. Perforators could be detected by vascular ultrasound before the operation. More than one perforator could be found most of the time. No severe complications occurred when performing a suitable plan, including discussing and recording the operation procedure; the focus of care, the choice for precise and proper perforators, and the mechanism for hiding the scars were all considered and recorded in a specific chart. Patients were satisfied with the reconstruction technique of peri-mammary artery perforator flaps after breast-conserving, and the satisfaction of AICAP and LICAP was higher. In general, this technique is suitable for partial breast reconstruction and has no negative impact on patient satisfaction.
在保乳手术中应用肿瘤整形技术时，容量置换是一项重要技术。中国临床应用乳晕动脉穿支皮瓣的情况参差不齐。在这里，我们描述了我们应用乳晕动脉皮瓣进行部分乳房重建的临床经验结果。
本研究中，30 例象限乳腺癌患者行部分乳房切除术，随后行乳晕动脉穿支皮瓣部分乳房重建，包括胸背动脉穿支皮瓣（TDAP）、肋间前动脉穿支皮瓣（AICAP）、肋间外侧动脉穿支皮瓣（LICAP）和胸外侧动脉穿支皮瓣（LTAP）。所有患者的手术方案均进行了全面讨论，并严格按照每一步进行操作。使用 BREAST-Q 版本 2.0 提取版和术前、术后乳房保留治疗模块量表评估满意度结果。
根据研究结果，皮瓣平均大小为 5.34.22.8cm（3.0-7.03.0-5.01.0-3.5cm）。平均手术时间为 142 分钟（100-250 分钟）。未发现部分皮瓣失败，无严重并发症。大多数患者对术后的着装、性生活和乳房形状感到满意。此外，手术区域的感觉、疤痕满意度和恢复状态逐渐改善。总体而言，在比较不同皮瓣时，LICAP 和 AICAP 的评分更高。
基于本研究，我们发现乳晕动脉皮瓣在保乳手术中具有重要价值，尤其是在乳房较小或中等大小的患者中。可以在手术前通过血管超声检测穿支。大多数情况下可以找到多个穿支。在制定合适的方案时，不会发生严重并发症，包括讨论和记录手术过程；关注重点、选择精确和适当的穿支以及隐藏疤痕的机制都在特定图表中进行了考虑和记录。患者对保乳术后乳晕动脉穿支皮瓣重建技术满意，AICAP 和 LICAP 的满意度更高。总的来说，该技术适用于部分乳房重建，对患者满意度没有负面影响。
