Pagliara Domenico, Pili Nicola, Serra Pietro Luciano, Schiavone Laurenza, Rubino Corrado, Ribuffo Diego, Salgarello Marzia, Rancati Alberto
Plastic-Reconstructive and Lymphedema Microsurgery Center, Mater Olbia Hospital, Olbia, Italy.
Department of Medical, Surgical and Experimental Sciences, Plastic Surgery Unit, University of Sassari, Sassari University Hospital Trust, Sassari, Italy.
Clin Breast Cancer. 2025 Jul;25(5):e578-e587. doi: 10.1016/j.clbc.2025.02.012. Epub 2025 Feb 27.
Conservative mastectomy is burdened by possible necrosis of the breast skin and nipple-areola complex, particularly among patients with macromastia and severe ptosis undergoing heterologous reconstruction. It is well known that anterior fifth intercostal artery perforator plays a critical role in nipple-areola complex blood supply. Our study investigates outcomes of large or ptotic breasts, undergoing immediate prepectoral direct-to-implant breast reconstruction covered by dermoadipose flap based on the fifth anterior intercostal artery perforator.
We conducted a retrospective study on 70 consecutive patients who underwent skin-reducing mastectomy, with or without nipple preservation, using an inverted T-pattern. Setup of a dermo-adipose flap with an inferior pedicle, based on the anterior intercostal artery perforator of the fifth intercostal space was performed, according to preoperative Doppler ultrasound. Immediate breast reconstruction was performed using Microthane implants. We assessed rate of mastectomy flap necrosis (Mayo Clinic Classification), at 12 months follow up, pre- and postmastectomy satisfaction with breast, physical well-being of the chest with BREAST-Q questionnaire, and spinal pain using the McGill Pain Questionnaire.
No complications such as hematoma, seroma, or implant infections occurred. Ischemic complications were observed in 11 cases (13.9%), however, only in one case was implant removal necessary. Satisfaction with breast appearance, chest physical well-being, and the pain rating index all significantly improved postoperatively.
Direct to implant reconstruction using the inferiorly pedicled flap based on the AICAP is a reliable and reproducible technique that offers favorable results with low complication rates in large or ptotic skin reducing mastectomies.
保乳手术可能会出现乳腺皮肤和乳头乳晕复合体坏死的情况，尤其是在巨乳症和重度乳房下垂患者进行异体乳房重建时。众所周知，第五肋间前动脉穿支在乳头乳晕复合体的血液供应中起着关键作用。我们的研究调查了基于第五肋间前动脉穿支的真皮脂肪瓣覆盖下，对大乳房或下垂乳房进行即刻胸前区直接植入式乳房重建的效果。
我们对70例连续接受倒T形皮肤缩减式乳房切除术（有或没有保留乳头）的患者进行了回顾性研究。根据术前多普勒超声检查结果，采用基于第五肋间间隙前肋间动脉穿支的带蒂下真皮脂肪瓣进行手术。使用Microthane假体进行即刻乳房重建。我们评估了乳房切除皮瓣坏死率（梅奥诊所分类法）、随访12个月时乳房切除前后对乳房的满意度、使用BREAST-Q问卷评估胸部的身体状况以及使用麦吉尔疼痛问卷评估脊柱疼痛情况。
未发生血肿、血清肿或假体感染等并发症。观察到11例（13.9%）出现缺血性并发症，但仅1例需要取出假体。术后对乳房外观、胸部身体状况和疼痛评分指数的满意度均显著提高。
基于第五肋间前动脉穿支的带蒂下皮瓣直接植入式重建是一种可靠且可重复的技术，在大乳房或下垂乳房的皮肤缩减式乳房切除术中并发症发生率低，效果良好。
