Ma J X, Xia Y C, Li B, Zhao H M, Lei Y T, Bu X
Department of Plastic Surgery, Peking University Third Hospital, Beijing 100191, China.
Department of General Surgery, Peking University Third Hospital, Beijing 100191, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2023 Aug 18;55(4):612-618. doi: 10.19723/j.issn.1671-167X.2023.04.007.
To investigate the choice of immediate breast reconstructive methods and asso-ciated outcomes after modified radical mastectomy.
Retrospective analysis of patients undergoing immediate breast reconstruction after modified radical mastectomy in Peking University Third Hospital from January 2009 to May 2019. The reconstructive methods were summarized, and the clinical outcomes and the safety of immediate breast reconstruction were evaluated.
One hundred and twenty-three patients were enrolled in this study. Different reconstructive methods were applied according to the clinical stage, the amount of skin removal, the size of contralateral breasts, the physical condition and the preference of the patients. Seventy-nine cases were performed with tissue expander/implant two-stage reconstruction, twenty-three cases received direct breast implant insertion, seven cases were applied for latissimus dorsi (LD) myocutaneous flap transfer combined with implant insertion, five cases were provided transverse rectus abdominis myocutaneous (TRAM) flap transfer, six cases underwent tissue expander/implant combined with endoscopic LD muscle flap transfer, and three cases chose tissue expander/deep inferior epigastric artery perforator (DIEP) flap transfer. The average follow-up time was (12.3±9.0) months (3.5-41.0 months). One patient with direct implant insertion had partial blood supply distur-bance of the mastectomy flap. One case had necrosis of distal end of TRAM zone Ⅳ. One patient with expander/DIEP reconstruction had partial fat liquefaction. And two cases had expander leakage at the end of the expansion period. The tumor local recurrence occurred in one patient, and the implant was finally removed. The outcomes were evaluated by Harris method, and 90.2% patients were good or above in shape evaluation. Among the patients with implant based reconstruction, there was no obvious capsular contracture, and most of the implants had good or fair mobility.
It is safe and feasible of immediate breast reconstruction after modified radical mastectomy for appropriate cases. The reconstructive methods can be individualized according to the individual's different conditions. The appropriate reconstructive methods could achieve satisfactory results.
探讨改良根治性乳房切除术后即刻乳房重建方法的选择及相关结局。
回顾性分析2009年1月至2019年5月在北京大学第三医院接受改良根治性乳房切除术后即刻乳房重建的患者。总结重建方法，评估即刻乳房重建的临床结局及安全性。
本研究共纳入123例患者。根据临床分期、皮肤切除量、对侧乳房大小、身体状况及患者意愿采用不同的重建方法。79例行组织扩张器/假体两步法重建，23例行直接乳房假体植入，7例行背阔肌肌皮瓣转移联合假体植入，5例行腹直肌横形肌皮瓣（TRAM）转移，6例行组织扩张器/假体联合内镜背阔肌肌瓣转移，3例行组织扩张器/腹壁下深动脉穿支（DIEP）皮瓣转移。平均随访时间为（12.3±9.0）个月（范围3.5 - 41.0个月）。1例直接假体植入患者出现乳房切除皮瓣部分血供障碍。1例TRAMⅣ区远端坏死。1例扩张器/DIEP重建患者出现部分脂肪液化。2例在扩张期末出现扩张器渗漏。1例患者出现肿瘤局部复发，最终取出假体。采用Harris法评估结局，90.2%的患者外形评价为良好及以上。在基于假体的重建患者中，无明显包膜挛缩，大多数假体活动度良好或尚可。
对于合适的病例，改良根治性乳房切除术后即刻乳房重建安全可行。重建方法可根据个体不同情况个体化选择。合适的重建方法可取得满意效果。
