保留乳头乳晕的乳房全切术后带蒂大网膜联合假体乳房一期重建23例

Immediate breast reconstruction with pedicled greater omentum and gel prosthesis following nipple and areola complex sparing mastectomy:a report of 23 cases

目的探讨保留乳头乳晕的乳房全切术后带蒂大网膜联合假体一期乳房重建的可行性和效果。方法选择湖南省肿瘤医院乳腺二科2013年8月至2015年9月收治的0、Ⅰ、Ⅱ期乳腺癌患者23例,所有患者按肿瘤切除原则先行保留乳头乳晕的乳房全切术,取上腹部小切口游离带蒂大网膜联合凝胶假体植入胸大小肌之间行乳房一期重建。结果 23例大网膜组织瓣全部成活,随访3-25个月,无一例假体移位、破裂,重建乳房外观自然、柔软、形态良好,其中2例导管内癌患者因术后预留乳头乳晕部位皮肤较薄出现了乳头缺血,颜色变黑,随访3个月,未见坏死。随访期间未见一例复发。结论保留乳头乳晕的改良根治术后带蒂大网膜联合假体一期乳房重建是一种安全可行且美容效果良好的手术方法。

Objective To discuss the feasibility and effect of immediate breast reconstruction with pedicled greater omentum and gel prosthesis following nipple and areola complex sparing mastectomy.Methods From August 2013 to September 2015,after mastectomy with conservation of nipple and areola,twenty-three patients with stage 0,Ⅰ,Ⅱ breast cancer accepted immediate breast reconstruction with pedicled greater omentum and gel prosthesis.Results All the pedicled greater omentum was successfully inserted,and no prosthesis migration and rupture occurred 3 to 25 months after operations.The reconstructed breast was good in shape and with soft feeling.Nipple ischemia occurred in two patients with ductal carcinoma in situ,while skin necrosis was not found within 3 months.There was no recurrence of breast cancer during follow-up period.Conclusion Immediate breast reconstruction with pedicled greater omentum and gel prosthesis after mastectomy with conservation of nipple and areola is an effective and safe procedure.