Feng L J, Mauceri K, Berger B E
Division of Plastic Surgery, Mount Sinai Medical Center, Case Western Reserve University, Cleveland, Ohio 44106.
Cancer. 1994 Jul 1;74(1 Suppl):440-9. doi: 10.1002/cncr.2820741333.
Concerns regarding the safety of silicone gel breast implants have motivated many patients with complications from their silicone breast implants to search for alternatives for breast reconstruction. Although autogenous tissue has been used for primary breast reconstruction after mastectomy, few studies have described its use in the patient in whom silicone-implant breast reconstruction has failed.
Between 1988 and 1993, 33 patients who had previous unsuccessful breast reconstruction with silicone breast implants underwent implant removal and autogenous tissue reconstruction. Preoperative evaluation included implant-related problems, such as capsular contracture, pain, and loss of implant shell integrity. Systemic symptoms that developed after implantation also were evaluated. Three types of myocutaneous flaps were used for breast reconstruction: the latissimus dorsi pedicle flap, the transverse rectus abdominis free flap, and the superior gluteus maximus free flap. Follow-up evaluation was done for both implant-related problems and issues related to patient satisfaction after autogenous tissue reconstruction.
The overall flap survival rate for 33 women who underwent flap reconstruction was 94%. All flap losses occurred in the first nine flaps. Ninety-two percent of patients felt their autogenous tissue reconstructions were aesthetically superior to their previous implant reconstruction. All but one patient felt complete resolution in their chest wall discomfort and pain. Eighty-one percent of patients with systemic symptoms also felt improvement in their systemic symptoms.
Autogenous tissue reconstruction from multiple areas of the body is an effective and aesthetically superior alternative for the patient who no longer desires the silicone implant option.
对硅胶乳房植入物安全性的担忧促使许多因硅胶乳房植入物出现并发症的患者寻求乳房重建的替代方法。尽管自体组织已用于乳房切除术后的一期乳房重建，但很少有研究描述其在硅胶植入物乳房重建失败患者中的应用。
1988年至1993年间，33例先前硅胶乳房植入物乳房重建失败的患者接受了植入物取出和自体组织重建。术前评估包括与植入物相关的问题，如包膜挛缩、疼痛和植入物外壳完整性丧失。还评估了植入后出现的全身症状。三种肌皮瓣用于乳房重建：背阔肌带蒂皮瓣、腹直肌游离皮瓣和臀大肌上半游离皮瓣。对与植入物相关的问题以及自体组织重建后患者满意度相关的问题进行了随访评估。
33例行皮瓣重建的女性皮瓣总体成活率为94%。所有皮瓣坏死均发生在前九个皮瓣中。92%的患者认为其自体组织重建在美学上优于先前的植入物重建。除一名患者外，所有患者的胸壁不适和疼痛均完全缓解。81%有全身症状的患者其全身症状也有所改善。
对于不再希望选择硅胶植入物的患者，来自身体多个部位的自体组织重建是一种有效且美学上更优的选择。
