Sun Jingjing, Wu Xiaodong, Yang Jing, Liang Jiahui, Ren Min
Department of Breast Surgery, Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
Department of General Surgery, Huangshan People's Hospital, Huangshan, China.
Microsurgery. 2023 Nov;43(8):809-817. doi: 10.1002/micr.31116. Epub 2023 Sep 25.
Large breast tumor resection can cause chest wall defects that are difficult to close. A combination of oncoplastic techniques is required to repair chest wall defects and immediately reconstruct the breast. In this report, we present the use of the contralateral internal mammary artery perforator (IMAP) flap to repair large chest wall defects and perform breast reconstruction for a series of patients.
Between July 2013 and June 2020, 10 patients and 4 patients underwent chest wall defect repair and breast reconstruction, respectively, with contralateral IMAP flaps. The average body mass index was 26.9 kg/m (range: 21.5-33.7 kg/m ). Tumor sizes varied from 2.5 × 1.5 × 0.8 to 9.5 × 6.0 × 4.0 cm . Defect sizes ranged from 16 × 10 to 8 × 4 cm . All patients underwent multiple imaging examinations to exclude abnormalities. Primary outcomes included complete tumor resection and flap survival. Secondary outcomes included the BREAST-Q results and bilateral breast symmetry measurements.
All flaps exhibited good postoperative survival and were between 20 × 12 and 10 × 5 cm . Two patients experienced minor complications that did not influence outcomes. No obvious donor site complications were observed. The BREAST-Q results indicated favorable reconstructive efficacy, with "satisfaction with breasts," "physical well-being (chest)," and "satisfaction with the outcome" scores of 77.8 (range: 58-87), 83.2 (range: 77-89), and 80.1 (range: 70-88), respectively. No signs of tumor recurrence were observed during a median follow-up period of 53.5 months (range: 6-83 months). However, poor postoperative bilateral breast symmetry was observed (vertical extent: 0.63 [range: 0.36-0.88]; horizontal extent: 0.64 [range: 0.41-0.80]).
IMAP flaps are reliable options for chest wall defect repair and breast reconstruction for selected patients with locally advanced breast cancer and inner breast tumors. Despite poor postoperative bilateral breast symmetry, most patients reported excellent outcomes.
大型乳腺肿瘤切除可导致胸壁缺损，难以闭合。需要联合应用肿瘤整形技术来修复胸壁缺损并即刻重建乳房。在本报告中，我们介绍了使用对侧胸廓内动脉穿支（IMAP）皮瓣修复一系列患者的大型胸壁缺损并进行乳房重建的情况。
2013年7月至2020年6月期间，分别有10例患者和4例患者接受了使用对侧IMAP皮瓣的胸壁缺损修复和乳房重建。平均体重指数为26.9kg/m²（范围：21.5 - 33.7kg/m²）。肿瘤大小从2.5×1.5×0.8cm至9.5×6.0×4.0cm不等。缺损大小从16×10cm至8×4cm不等。所有患者均接受了多项影像学检查以排除异常。主要结局包括肿瘤完整切除和皮瓣存活。次要结局包括BREAST - Q结果和双侧乳房对称性测量。
所有皮瓣术后均存活良好，大小在20×12cm至10×5cm之间。2例患者出现轻微并发症，但未影响结局。未观察到明显的供区并发症。BREAST - Q结果显示重建效果良好，“对乳房的满意度”“身体幸福感（胸部）”和“对结果的满意度”评分分别为77.8（范围：58 - 87）、83.2（范围：77 - 89）和(80.1)（范围：70 - 88）。在中位随访期53.5个月（范围：6 - 83个月）内未观察到肿瘤复发迹象。然而，术后观察到双侧乳房对称性较差（垂直范围：0.63[范围：0.36 - 0.88]；水平范围：0.64[范围：0.41 - 0.80]）。
对于部分局部晚期乳腺癌和内侧乳腺肿瘤患者，IMAP皮瓣是胸壁缺损修复和乳房重建的可靠选择。尽管术后双侧乳房对称性较差，但大多数患者报告结局良好。
