Hallock G G
Division of Plastic Surgery, Lehigh Valley Hospital, Allentown, PA.
Ann Plast Surg. 1995 Apr;34(4):406-8. doi: 10.1097/00000637-199504000-00012.
Sequential as opposed to synchronous autogenous tissue bilateral breast reconstruction imposes a dilemma because of the increasing complexity of the usually few remaining options. This fact became evident 4 years after an ipsilateral superior-pedicled lower transverse rectus abdominis musculocutaneous (TRAM) flap for left-breast reconstruction was successful in a patient who only then desired a prophylactic contralateral mastectomy but also demanded breast symmetry without implants. Without resorting to microsurgical transfers and foregoing local delay tactics, a right-breast facsimile was formed via an adaptation of breast-sharing principles. Transverse splitting of the original TRAM flap with re-elevation of the inframammary half of the reconstructed breast still maintained viability through the retained medial left rectus abdominis muscle pedicle. This second TRAM flap was immediately transposed to the opposite side without incident. Although only a fair overall aesthetic result was possible, the patient's expectation for having two "breasts" was met.
与同步自体组织双侧乳房重建相反，序贯性自体组织双侧乳房重建带来了一个两难困境，因为通常所剩无几的选择变得越来越复杂。这一情况在一名患者身上得到了体现，该患者在接受了用于左乳房重建的同侧上蒂下腹部横行腹直肌肌皮瓣（TRAM瓣）4年后，成功进行了左乳房重建。当时，该患者希望进行预防性对侧乳房切除术，同时要求不使用植入物的乳房对称。在不采用显微外科转移和放弃局部延迟策略的情况下，通过采用乳房共享原则，形成了一个右乳房复制品。将原始TRAM瓣横向劈开，重新掀起重建乳房的乳房下部分，通过保留的左侧腹直肌内侧肌蒂，该部分仍保持活力。第二个TRAM瓣立即转移到对侧，未出现任何问题。尽管总体美学效果一般，但患者拥有两个“乳房”的期望得到了满足。
