扩大背阔肌肌皮瓣乳房再造

Breast reconstruction with extended latissimus dorsal myocutaneous flap

目的介绍单纯应用扩大背阔肌肌皮瓣进行乳房再造的方法。方法将背阔肌周围脂肪组织分为5个区,切取背阔肌及周围脂肪组织,不应用乳房假体,进行即时或延期乳房再造。结果应用该方法再造乳房261例,其中保留乳头乳晕改良根治术后即时再造124例,保留皮肤改良根治术后即时再造43例,改良根治术后即时再造56例,延期再造38例;再造乳房均形态良好。术后16例出现乳头部分坏死;14例胸部皮肤表皮脱落,自行愈合;2例背部供区部分坏死;3例发生背部顽固性血肿,再次手术后愈合。结论扩大背阔肌肌皮瓣乳房再造安全、有效,再造乳房形态良好,尤其适用于中、小乳房的乳房再造。

Objective To introduce our experience about immediate and delayed breast reconstruction using extended latissimus dorsal myocutaneous flap without breast implant. Methods The fatty tissue around the latissimus dorsal muscle was classified into 5 zones. Breast reconstruction was performed with latissimus dorsal myocutaneous flap and surrounding fat tissue, without breast implant. Results Breast reconstruction was performed in 261 patients with extended latissimus dorsal myocutaneous flap, with 124 cases receiving immediate breast reconstruction after nipple sparing modified radical mastectomy, 43 cases after skin sparing modified radical mastectomy and 56 cases after modified radical mastectomy, and the rest 38 cases receiving delayed breast reconstruction. The morphology of reconstructed breasts was excellent. After operation 16 cases had partial nipple necrosis, 14 cases had rhacoma of the chest, but cured automatically, 2 cases had necrosis on part of the donor side, and 3 cases had seroma on the back and cured by reoperation. Conclusions Breast reconstruction with extended latissimus dorsal myocutaneous flap is safe and effective, especially suitable to breast reconstruction with small and medium size breasts.