Scaglioni Mario F, Martini Federica, Meroni Matteo
Plastic Surgery Pyramide, Haus zur Pyramide, 8008 Zurich, Switzerland.
Department of Health Sciences and Medicine, University of Lucerne, 6005 Lucerne, Switzerland.
J Clin Med. 2025 Apr 10;14(8):2599. doi: 10.3390/jcm14082599.
Autologous breast reconstruction has undergone a remarkable evolution, driven by the pursuit of addressing past concerns primarily related to donor site morbidity and complication risks. Improved techniques now prioritize minimizing invasiveness, complications, and recovery time while achieving aesthetically pleasing and durable results. Recent advancements in autologous breast reconstruction have been examined, focusing on enhancements in surgical techniques, imaging technologies, minimally invasive approaches, and postoperative care. To reduce donor site morbidity, attention has recently shifted back to abdominal flaps vascularized by subcutaneous vessels. Specifically, the superficial circumflex iliac artery perforator (SCIP) flap has emerged as a promising option. Additionally, robotic-assisted flap harvest serves as another method to reduce the invasiveness. At the recipient site, rib-sparing internal mammary vessel isolation and perforator-to-perforator anastomosis have been suggested to lessen trauma and maintain thoracic integrity. The use of thorough preoperative imaging and intraoperative assessment of real-time perfusion with indocyanine green angiography (ICG) has enhanced the success of the procedure. Beyond aesthetic restoration, contemporary breast reconstructive surgeons are increasingly aware of both short-term and long-term complications, particularly lymphatic sequelae. The LYMPHA technique (lymphatic microsurgical preventive healing approach) promotes immediate restoration of the lymphatic system and has shown the potential to reduce the risk of breast cancer-related lymphedema (BCRL). Furthermore, the integration of enhanced recovery after surgery (ERAS) protocols has transformed perioperative care by optimizing pain management, minimizing hospitalization duration, and allowing a quicker return to daily activities. Recent advancements in autologous breast reconstruction have significantly improved patient outcomes. With innovations in flap design, technology, lymphatic preservation, and recovery protocols, it has been possible to usher in a new era of less invasive procedures and fewer complications while achieving high aesthetic results and allowing patients to return to their daily lives as quickly as possible.
自体乳房重建技术经历了显著的发展，这一发展是由解决过去主要与供区并发症和并发症风险相关的问题所推动的。如今，改进后的技术将重点放在最大限度地减少侵入性、并发症和恢复时间上，同时实现美观且持久的效果。本文探讨了自体乳房重建的最新进展，重点关注手术技术、成像技术、微创方法和术后护理的改进。为了降低供区并发症，最近的注意力又回到了由皮下血管供血的腹部皮瓣上。具体而言，旋髂浅动脉穿支（SCIP）皮瓣已成为一个有前景的选择。此外，机器人辅助皮瓣切取是另一种减少侵入性的方法。在受区，有人建议采用保留肋骨的胸廓内血管分离和穿支对穿支吻合术，以减轻创伤并保持胸廓完整性。术前进行全面的成像检查以及术中使用吲哚菁绿血管造影（ICG）对实时灌注进行评估，提高了手术的成功率。除了美学修复外，当代乳房重建外科医生越来越意识到短期和长期并发症，尤其是淋巴系统后遗症。LYMPHA技术（淋巴显微外科预防性愈合方法）可促进淋巴系统的即时恢复，并已显示出降低乳腺癌相关淋巴水肿（BCRL）风险的潜力。此外，术后加速康复（ERAS）方案的整合通过优化疼痛管理、缩短住院时间并使患者更快恢复日常活动，改变了围手术期护理。自体乳房重建的最新进展显著改善了患者的治疗效果。通过皮瓣设计、技术、淋巴保留和恢复方案的创新，有可能开创一个侵入性更小、并发症更少的新时代，同时实现高美学效果，并让患者尽快恢复日常生活。
