Sapino Gianluca, Tay Sherilyn K, Maruccia Michele, Nanhekhan Lloyd, Watfa William, Mantovani Gian Piero, Guillier David, Tedeschi Pasquale, Bramhall Russell, Di Summa Pietro Giovanni
Department of Plastic and Hand Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), 1011 Lausanne, Switzerland.
Canniesburn Plastic Surgery Department, Glasgow Royal Infirmary, Glasgow G4 0SF, UK.
J Clin Med. 2023 Sep 22;12(19):6135. doi: 10.3390/jcm12196135.
Nowadays, the ultimate goal of microsurgical breast reconstruction is not merely the effective transfer of vascularized tissue but the achievement of a natural, symmetric appearance. The aim of this present study was to systematically summarize the published evidence on abdominal-based free flap inset for breast reconstruction in order to provide principles and classification that could guide the surgeon in choosing the most appropriate inset technique based on patient and flap characteristics. A comprehensive review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, looking for articles on the insetting technique for free flap breast reconstruction. After screening 306 publications, 24 papers (published from 1994 to 2020) were included in the study. We identified four main breast anatomical features on which the papers reviewed focused when describing their insetting technique: breast width, breast ptosis, breast projection, and upper pole fullness. Patient body type, type of mastectomy, and reported complications are also discussed. Flap shaping and inset during breast reconstruction are fundamental steps in any reconstructive procedure. Despite the low evidence in the current literature, this systematic review provides a framework to guide the surgeon's decision-making and optimize the aesthetic outcomes of abdominal-based free flap breast reconstruction.
如今，显微外科乳房重建的最终目标不仅是有效转移带血管组织，更是实现自然、对称的外观。本研究的目的是系统总结已发表的关于基于腹部的游离皮瓣植入乳房重建的证据，以便提供原则和分类方法，指导外科医生根据患者和皮瓣特征选择最合适的植入技术。按照系统评价和Meta分析的首选报告项目（PRISMA）指南进行了全面综述，查找有关游离皮瓣乳房重建植入技术的文章。在筛选了306篇出版物后，24篇论文（发表于1994年至2020年）被纳入研究。我们确定了在描述植入技术时，所审查论文重点关注的四个主要乳房解剖特征：乳房宽度、乳房下垂、乳房突出度和上极丰满度。还讨论了患者体型、乳房切除术类型和报告的并发症。乳房重建过程中的皮瓣塑形和植入是任何重建手术的基本步骤。尽管当前文献中的证据有限，但本系统综述提供了一个框架，以指导外科医生的决策并优化基于腹部的游离皮瓣乳房重建的美学效果。
