经乳晕环形切口皮下乳腺切除与即刻腹直肌肌皮瓣再造术

Skin sparing incision mastectomy and immediate TRAM flap breast reconstruction

目的 为完善和提高再造乳房的质量 ,使患早期乳腺癌的病人更容易接受乳房再造手术。方法 选择患乳腺导管内原位癌的病人 ,经乳晕切口活检做病理检查确立诊断 ,采用乳晕环形切口行保留乳房皮肤的乳腺皮下切除术 ,应用腹直肌肌皮瓣即刻再造乳房 ,仅以少量的肌皮瓣皮肤弥补切除的乳头、乳晕 ,在此皮瓣上再造乳头 ,经文身使乳头、乳晕色泽与健侧一致。结果 此方法再造的乳房瘢痕较少 ,且隐蔽 ,外观形态自然 ,易与健侧对称 ,保留了乳房皮肤的良好感觉 ,但手术适应证选择要严格 ,以免术后乳腺癌复发 ,术中切除乳腺需彻底但又不能损伤乳房皮肤和皮下组织 ,其过程需多专科协作完成。结论 在严格选择手术适应证的前提下 ,经多专科协作完成的该术式 。

Objective In order to achieve a high\|quality reconstructed breast, we improved the operation method using the skin sparing incision mastectomy and immediate TRAM flap breast reconstruction. Methods Patients with duct carcinoma in situ were selected to undergo mastectomy with a skin sparing incision. The site of the previous biopsy incision was marked around the areola, and then the preferred skin sparing incision included the nipple\|areola complex and a margin around the biopsy site for the non\|ptotic breast. The excised skin was replaced as precisely as possible with the TRAM flap skin immediately. While the mastectomy was being performed the TRAM flap was incised and elevated. The pedicled or free TRAM flap has been used for 34 patients. Nipple\|areola reconstruction was made at the second stage. Results The results of the skin sparing breast reconstruction are better than other breast reconstruction techniques in the breast's shape,colour,sensation,symmetry and incision scar. Conclusions Skin sparing incision mastectomy with immediate TRAM flap breast reconstruction technique is an ideal breast reconstructive method for the patients with breast duct carcinoma in situ. The advantages of the method include ① The TRAM flap is an autograft without rejection; ② The reconstructed breast has good shape and better sensation than other autograft reconstructive techniques since most breast skin has been spared; ③ The symmetry of the reconstructed breast with the contralateral breast is improved.