硅胶假体及脱细胞真皮辅助女性Poland综合征患者的乳房再造

Breast reconstruction with silicone implants and acellular dermal matrix in women with Poland syndrome

背景:女性Poland综合征患者同时伴有乳房发育不全甚至不发育,乳房缺失及乳房畸形等,可根据畸形程度实施背阔肌肌瓣转移、脱细胞真皮组织或乳房硅胶假体植入重塑乳房、改善胸部外形。目的:探索乳房硅胶假体及脱细胞异体真皮在女性Poland综合征患者乳房缺如畸形再造中的应用,评价其早期临床效果。方法:回顾性分析6例女性Poland综合征患者临床资料,其中单侧(双侧)乳房缺如、患侧(双侧)胸大肌发育不全、胸壁组织量较健侧略差4例,接受乳房硅胶假体植入治疗;单侧乳房缺如、患者胸大肌缺如、肋骨缺如、胸壁软组织菲薄且粘连2例,接受乳房硅胶假体及脱细胞真皮植入联合背阔肌肌瓣转移治疗。结果与结论:6例植入后4 d时均有水肿,1例切口渗液,均甲级愈合。术后随访1-12个月,3例可触及假体轮廓,1例乳房为中等硬度,均无乳房结节及疼痛,切口瘢痕无增生,乳房外观均匀,无乳房起皱。证实乳房硅胶假体及脱细胞异体真皮辅助女性Poland综合征乳房畸形矫正,操作方便,可减少术中损伤,降低手术难度并减轻患者痛苦,在严格把握适应证的前提下可取得较好临床效果。

BACKGROUND：Women with Poland syndrome are often accompanied by breast dysplasia and even agenesis, absence of breast and breast deformity. For such patients, we can implement different operations according to the degree of deformity, for remodeling the breast and improving chest shape. OBJECTIVE：To explore the clinical effects of breast reconstruction with silicone implants and acellular dermal matrix in Poland patients with breast deformity. METHODS：A retrospective analysis of six female cases of Poland syndrome was conducted, including four patients with unilateral （bilateral） breast agenesis, hypoplasia of the ipsilateral （bilateral） pectoralis major muscle, less tissue volume than the healthy side who were subjected to implantation of silicone breast prostheses, and two patients with unilateral breast agenesis, agenesis of the pectoralis major muscle and ribs, poor and adhered chest wal soft tissue who were subjected to implantation of silicone breast prosthesis and acellular dermal matrix combined with latissimus dorsi myocutaneous flap. RESULTS AND CONCLUSION：Six patients at day 4 after operation presented with edema, among whom, one appeared to have wound exudate. But al the six patients were healed. Then, the patients were fol owed up for 1-12 months. Outline of breast prosthesis could be touched in three cases, and one case presented with moderate hardness of the breast. However, there were no breast nodules and pain, no scar hyperplasia of the breast. Breast was uniform in appearance, with no wrinkle. These findings confirm that the silicone breast prosthesis with acellular dermal matrix is easy to operate, can reduce intraoperative injury, decrease the difficulty of the operation and al eviate the suffering of patients, which can obtain better clinical effects in the strict grasp of indications.