Song Yuhang, Zeng Jiahui, Tian Xingchen, Zheng Hongmei, Wu Xinhong
Department of Breast Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei Provincial Clinical Research Center for Breast Cancer, Wuhan Clinical Research Center for Breast Cancer No. 116 Zhuo Daoquan South Road, Wuhan 430079, Hubei, China.
Am J Transl Res. 2023 Jun 15;15(6):3846-3855. eCollection 2023.
Breast reconstruction is necessary for the comprehensive treatment of breast cancer. For successful breast reconstruction, the timing of surgery and the surgical methods used are vital. The methods of breast reconstruction can be divided into implant-based breast reconstruction (IBBR) and autologous breast reconstruction (ABR). With the development of acellular dermal matrix (ADM), IBBR has become more common in clinical practice. However, the choice for the position in which the implant should be placed (prepectoral or subpectoral) and the use of ADM is currently controversial. We summarized the differences in indications, complications, advantages, disadvantages, and prognosis between IBBR and ABR. We also compared the indications and complications of different flaps in ABR and found that the LD (latissimus dorsi) flap is suitable for Asian women who have a low body mass index (BMI) and a low incidence of obesity, while the DIEP (deep inferior epigastric perforator) flap can be used in patients with severe breast ptosis. In conclusion, immediate breast reconstruction with an implant or expander is the primary method, as it causes lesser scarring and requires a shorter time compared to ABR. However, for patients with severe breast ptosis or reluctant to receive an implant, ABR can be performed for a satisfying cosmetic result. Indications and complications of different flaps in ABR are also inconsistent. Surgeons should make surgical plans based on the preferences and conditions of each patient. In the future, breast reconstruction methods need to be further refined, and minimally invasive and personalized approaches need to be implemented to provide more benefits to patients.
乳房重建是乳腺癌综合治疗所必需的。对于成功的乳房重建而言，手术时机和所采用的手术方法至关重要。乳房重建方法可分为植入物乳房重建（IBBR）和自体乳房重建（ABR）。随着脱细胞真皮基质（ADM）的发展，IBBR在临床实践中变得更为常见。然而，目前植入物放置位置（胸大肌前或胸大肌后）的选择以及ADM的使用存在争议。我们总结了IBBR和ABR在适应证、并发症、优缺点及预后方面的差异。我们还比较了ABR中不同皮瓣的适应证和并发症，发现背阔肌（LD）皮瓣适用于体重指数（BMI）低且肥胖发生率低的亚洲女性，而腹壁下深动脉穿支（DIEP）皮瓣可用于重度乳房下垂患者。总之，使用植入物或扩张器进行即刻乳房重建是主要方法，因为与ABR相比，它造成的瘢痕较小且所需时间较短。然而，对于重度乳房下垂或不愿接受植入物的患者，可进行ABR以获得满意的美容效果。ABR中不同皮瓣的适应证和并发症也不一致。外科医生应根据每位患者的偏好和情况制定手术方案。未来，乳房重建方法需要进一步完善，并且需要实施微创和个性化方法，以便为患者带来更多益处。
