Cho Min-Jeong, Schroeder Michael, Flores Garcia Jorge, Royfman Abigail, Moreira Andrea
Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43201, USA.
Department of Plastic and Reconstructive Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15261, USA.
J Clin Med. 2025 Feb 25;14(5):1543. doi: 10.3390/jcm14051543.
: Modern breast reconstruction has undergone substantial evolution, with implant-based, pedicled autologous, and free autologous techniques. The purpose of this study is to review the current state of the art in free autologous breast reconstruction, highlighting advancements in the types of flaps, donor site selection, techniques, and functional restoration. : A literature review was conducted using PubMed to capture studies related to well-known free flaps that are used for breast reconstruction. Studies for each flap type were reviewed and sorted for inclusion into one of six categories: (1) clinical outcomes, (2) comparison studies of alternative flaps, (3) preoperative planning, (4) flap classifications and perfusion zones, (5) technique descriptions, and (6) time and cost analyses. : The majority (77%) of articles included were written on various types of abdominally based free flaps, including TRAM, DIEP, and SIEA flaps. These studies indicated an evolution in technique over time to minimize donor site morbidity, improve patient-reported and functional outcomes, improve efficiency, and expand clinical indications. The remaining 23% of articles discussed alternative flap choices, including PAP, TUG, S/IGAP, and LAP flaps. Studies highlighted technical challenges and the evolution of techniques to make these flaps more accessible, as well as how to combine flaps to expand clinical indications. : Autologous breast reconstruction has evolved significantly, with advancements in techniques such as robotic-assisted surgery, multi-flap reconstruction, bipedicled flaps, and neurotization. This review highlights the current best practices while acknowledging ongoing challenges and the potential for future innovations in microsurgery, nerve regeneration, and personalized medicine, which hold promise for further refining outcomes.
现代乳房重建技术经历了重大发展，包括基于植入物的、带蒂自体组织和游离自体组织技术。本研究的目的是回顾游离自体组织乳房重建的当前技术水平，重点介绍皮瓣类型、供区选择、技术和功能恢复方面的进展。
使用PubMed进行文献综述，以获取与用于乳房重建的知名游离皮瓣相关的研究。对每种皮瓣类型的研究进行了综述和分类，纳入以下六个类别之一：（1）临床结果，（2）替代皮瓣的比较研究，（3）术前规划，（4）皮瓣分类和灌注区，（5）技术描述，以及（6）时间和成本分析。
纳入的文章中，大多数（77%）是关于各种类型的腹部游离皮瓣，包括横行腹直肌肌皮瓣（TRAM）、腹壁下动脉穿支皮瓣（DIEP）和腹壁浅动脉穿支皮瓣（SIEA）。这些研究表明，随着时间的推移，技术不断发展，以尽量减少供区并发症，改善患者报告的结果和功能结果，提高效率，并扩大临床适应症。其余23%的文章讨论了替代皮瓣选择，包括臀大肌穿支皮瓣（PAP）、股薄肌肌皮瓣（TUG）、肩胛下动脉穿支皮瓣（S/IGAP）和侧胸皮瓣（LAP）。研究强调了技术挑战以及使这些皮瓣更易于应用的技术发展，以及如何联合皮瓣以扩大临床适应症。
自体组织乳房重建技术有了显著发展，如机器人辅助手术、多皮瓣重建、双蒂皮瓣和神经化等技术取得了进展。本综述强调了当前的最佳实践，同时也认识到持续存在的挑战以及显微外科、神经再生和个性化医疗未来创新的潜力，这些创新有望进一步优化治疗结果。
