应用背阔肌肌皮瓣即刻乳房及乳头再造

Immediate breast and nipple reconstruction with the latissimus dorsi myocutaneous flap

目的探讨保留皮肤的乳癌改良根治术后，应用背阔肌肌皮瓣即刻行乳房及乳头再造术的可行性。方法24例乳癌患者行保留皮肤的乳癌改良根治术后，应用背阔肌肌皮瓣联合或不联合乳房假体，即刻行乳房再造术，并利用背阔肌肌皮瓣皮岛设计改良箭头皮瓣，同时行乳头再造术。结果2例再造乳头出现部分坏死，坏死面积分别为10％和6％，均经换药后愈合。所有患者均在术后6、12个月进行随访，再造乳头平均回缩率分别为35．4％、38．6％。随访12个月，3例出现假体包膜挛缩（BakerI级），未行手术修整。91．7％的患者对乳房形状非常满意和满意，83．3％对乳房体积非常满意和满意，100％对乳头形状非常满意和满意，91．6％对乳头突度非常满意和满意。91．7％的患者认为即刻乳头再造非常重要，无患者认为即刻乳头再造不重要；66．7％的患者认为再造乳房完全替代了原有乳房，25％的患者认为可以部分替代原有乳房。结论保留皮肤的乳癌改良根治术后，应用背阔肌肌皮瓣即刻行乳房及乳头再造术，可获得良好的美学效果。

Objective To investigate the feasibility of immediate breast and nipple-areota reconatruction after skin-sparing mastectomy. Methods 24 patients who received skin,sparing mastectomy underwent immediate breast reconstruction with or without breast implants. The nipple-areola complex is also reconstructed with the skin paddle of the latissimus dorsi flap in one stage, Results All the latissimus dorsi myocutaneous flaps survived completely. Partial necrosis happened in t^o recom xucted nipples which healed after dress changing. The follow-up period ranged from 6 to 12 months. 3 patients preaented with capsular contracture （ Baker I ） ,with no necessary of surgical revision. The retraction rate of reconstructed nipples projection is 35.4% at 6 months postoperatively and 38.6% at 12 months postoperatively. 91.7% of patients were satisfied or very satisfied with the breast shape, while 83.3% were satisfied or very satisfied with the breast volume. All the patients considered the reconstructed nipple very good, while 91.6% were satisfied with the nipple projection. 91.7% considered immediate nipple reconstruction to be very important, and 8.3% considered it to be important. 66.7% considered the new breast could replace the breast they had lost, and 8.3% considered that it could not. Conclusion For skin-sparing mastectomy, immediate breast and nipple reconstruction can achieve good aesthetic results.