综合运用肿瘤整形技术修复保留乳房手术相关乳房局部缺损

Comprehensive application of oncoplastic techniques in repairing breast conserving therapy related breast malformation

目的随着乳腺外科技术的不断进步,在治愈乳腺癌的同时追求更佳的术后乳房形态是外科医生与患者共同的追求。本研究综合运用肿瘤整形技术个体化修复乳腺癌保留乳房手术后的局部缺损。方法 2003-01-01-2017-01-01医院收治单侧乳腺癌患者9例。由乳腺外科医师实施乳腺癌切除保留乳房手术,根据患者临床病理情况决定是否保留乳头乳晕。整形外科医师根据患者术前乳房形态和术中患侧乳房组织缺损情况,选择肿瘤整形的修复方法。即刻修复病例8例,1例采用局部皮瓣转移修复同侧乳房外侧缺损;背阔肌肌皮瓣转移4例,其中1例形成同侧背阔肌肌皮瓣及肌瓣,分别修复乳房内侧象限缺损及腋窝淋巴清除后的缺损;2例采用肋间动脉穿支皮瓣修复保留乳房术后的局部缺损;1例乳腺癌合并双侧巨乳者采用巨乳缩小技术修复乳房中央区缺损、双叶瓣法即刻乳头再造并行对侧乳房的缩小及上提。二期修复病例1例采用双侧腹壁下动脉穿支皮瓣吻合血管的游离移植修复乳房局部缺损。结果 9例患者术后均恢复良好,未出现乳头乳晕血运障碍及局部皮瓣的血运障碍,乳房形态对称,手感柔软,无大范围硬结及血肿,未出现切口感染等并发症。患者对术后乳房形态满意。放化疗后未见切口并发症。随访20～122个月,乳房形态稳定,未见局部复发及远处转移。结论综合运用肿瘤整形技术有助于提高乳腺癌患者保留乳房手术成功率并获得良好的乳房形态。

OBJECTIVE To apply oncoplastic techniques comprehensively in breast conserving therapy related breast malformation in order to achieve a better outcome.METHODS Nine unilateral breast cancer patients were involved.From Jan 1st,2003 to Jan 1st,2017.Breast conserving therapy was performed by breast surgeons team.Nipple sparing or not was decided according to the margin of the tumor.Breast individualized oncoplasty and restroration was performed by plastic surgeons team.Eight cases received immediate restoration.One case received local flap for the lateral breast defect.Four cases received latissimus dorsi flap,one of which repaired the medial breast and ALND related axillary defect within the same flap.Two cases received intercostal artery perforator flap.One unilateral breast cancer combined with bilateral macromastia patient received bilateral breast reduction and double-fan flap nipple reconstruction.The reduction mammoplasty and lifting was also performed on the contralateral breast to achieve better symmetry.One delayed restoomion case reccived bilateral DIEP flap to repair the breast conserving surgery related breast defect.RESULTS All the9 cases showed good symmetry and soft breast outcomes without major and minor complications,like nipple necrosis,local flap necrosis,haematoma and infections.All the patients were satisfied with the outcome of breast conservation therapy and no advanced incision complication occurred after radiotherapy.Within 12-122 months follow up,the appearance was stable,and no local recurrence or metastasis was observed.CONCLUSION Comprehensive oncoplastic techniques improves breast conserving therapy outcomes.