Berkane Yanis, Beaufils Tristan, Alabdulkareem Mohammad, Abu Qasida Alla, Scarabosio Anna, Girard Paul, Watier Eric, Bertheuil Nicolas
From the Department of Plastic, Reconstructive and Aesthetic Surgery, Rennes University Hospital Center, Rennes, France.
Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
Plast Reconstr Surg Glob Open. 2024 Oct 4;12(10):e6223. doi: 10.1097/GOX.0000000000006223. eCollection 2024 Oct.
Breast reconstruction in postbariatric patients presents unique challenges due to substantial weight loss-induced body deformities. We present the case of a 51-year-old woman with massive lower abdominal deformities who underwent a mastectomy treatment followed by a temporary expander-based reconstruction. A year later, a fleur-de-lis-shaped free deep inferior epigastric artery perforator flap and abdominoplasty were performed for autologous reconstruction and abdominal contouring. This design addressed both purposes while allowing a voluminous flap to be harvested on periumbilical perforators. No postoperative complications were found, and the outcomes were favorable. Although deep inferior epigastric artery perforator flaps are standard in autologous breast reconstruction, our case demonstrates the utility of the fleur-de-lis design in massive weight loss patients for vascular safety and volume enhancement. Finally, we discuss this rarely described approach and compare it with other variants, showcasing versatility in addressing complex reconstruction needs in this particular patient population.
减肥后患者的乳房重建因大量体重减轻导致身体畸形而面临独特挑战。我们报告一例51岁女性患者，其下腹部有严重畸形，接受了乳房切除治疗，随后进行了基于临时扩张器的重建。一年后，采用百合花形状的游离腹壁下深动脉穿支皮瓣和腹壁成形术进行自体重建和腹部塑形。这种设计在实现两个目的的同时，还能在脐周穿支上切取大量皮瓣。未发现术后并发症，效果良好。虽然腹壁下深动脉穿支皮瓣是自体乳房重建的标准术式，但我们的病例展示了百合花设计在大量体重减轻患者中对于血管安全和增加容量的实用性。最后，我们讨论了这种很少被描述的方法，并将其与其他变体进行比较，展示了在满足这一特殊患者群体复杂重建需求方面的多功能性。
