前锯肌肌瓣在乳腺癌改良根治术后即刻乳房再造中的应用

Application of serratus anterior muscle flap combined with breast implants for breast reconstruction after modified radical mastectomy

目的探讨前锯肌肌瓣联合假体植入在乳腺癌改良根治术后即刻乳房再造中的应用。方法 2015年1月—12月收治25例乳腺癌女性患者,年龄24~62岁,平均40.6岁。左侧9例,右侧16例。均为浸润性导管癌。TNM分期:Ⅰ期14例,ⅡA期11例。肿瘤位于乳房外上象限14例,上方7例,外下象限4例;均为单发肿块,肿块直径均<3 cm;无远处转移。前哨淋巴结均为阴性。改良根治术后,采用前锯肌肌瓣联合假体植入即刻再造乳房,其中22例保留乳头乳晕。结果手术时间113~148 min,平均136 min。术后再造乳房均全部成活,切口均Ⅰ期愈合,无血肿、感染等并发症发生。患者均获随访,随访时间6~18个月,平均15个月。除1例未随访达12个月外,其余患者术后12个月时参照再造乳房评价标准,获良23例、中1例。随访期间无肿瘤复发。结论乳腺癌改良根治术后采用前锯肌肌瓣联合假体植入即刻乳房再造,操作简便、损伤小、术后并发症少、再造乳房形态良好,患者满意度高。

Objective To investigate effectiveness of the combination of serratus anterior muscle flap and breast implants for breast reconstruction after modified radical mastectomy. Methods Between January 2015 and December 2015, 25 female patients with breast cancer were enrolled, aged 24-62 years （mean, 40.6 years）. The tumor located at left side in 9 cases and right side in 16 cases; 14 cases were in the left upper quadrant, 4 cases were in the left lower quadrant, 7 cases were on the top of the breast. All cases were invasive ductal carcinoma. According to TNM staging, 14 cases were at stage I and 11 cases were at stage II A. The diameter of lumps were all less than 3 cm. All those lumps were solitary and without distant metastasis. The sentinel nodes were all negative. After modified radical mastectomy, the breasts were reconstructed by serratus anterior muscle flap and breast implants. The nipples were spared in 22 cases. Results The operation time was 113-148 minutes （mean, 136 minutes）. All breasts survived and incisions healed at stage I . There was no complication such as hematoma, infection, etc. All patients were followed up 6-18 months （mean, 15 months）. Except 1 case, the others were evaluated according to the criteria of the reconstructed breast at 12 months after operation. Among them, 23 cases were evaluated as good and 1 case as fair. There was no tumor recurrence during the follow-up period. Conclusion The combination of serratus anterior muscle flap and breast implants after the modified radical mastectomy is a handy approach of breast reconstruction which is less harmful with few postoperative complications. It also gains a high degree of satisfaction from patients for good breast shape.