自体脂肪移植用于乳房再造的临床效果

Application of autologous fat grafting in breast reconstruction

目的观察自体脂肪移植用于乳腺癌术后患者乳房再造的临床效果。方法回顾性分析2012年1月至2015年3月在中国医学科学院整形外科医院形体雕塑与脂肪移植中心接受治疗的22例乳腺癌改良根治术后乳房再造患者的临床资料。患者均为女性，年龄28～54岁；15例为乳腺癌改良根治术后5～16年，未行放疗，7例为乳腺癌改良根治术后定期放疗结束后2年。所有患者应用低负压细管抽吸自体脂肪400～800ml，低温环境下应用棉垫法进行脂肪颗粒浓缩，多层次、多隧道、多点注射脂肪，术后每3个月应用MRI或超声进行影像学评估随访。结果所有患者顺利完成手术，未出现严重并发症，15例未放疗患者中，12例多次应用自体脂肪再造乳房，3例多次应用自体脂肪注射后再进行假体植入：7例放疗患者中．6例多次应用自体脂肪注射，1例多次自体脂肪注射后再进行假体植入。吸脂手术时间1．0—1．5h．脂肪注射时间约40min，总手术时间约2．5h，每次脂肪注射量104～380ml。间隔3个月以上进行下次手术。术后MRI显示21例患者脂肪存活良好．未见脂肪坏死、液化现象，1例患者乳房皮下组织内触及小的结节样肿物，行乳头再造时予以切除。18例患者超声图像显示再造乳房内有少量最大径0．1～0．2cm的囊性结节，触诊无异常。随访18～36个月，效果满意。结论自体脂肪移植乳房再造术避免了应用皮瓣法进行乳房再造的并发症．简化了手术步骤，可以获得良好的长期效果。

Objective To observe the outcome of breast reconstruction with autologous fat grafting in the patients following treatment for breast cancer. Methods The clinical data of ：22 patients after breast cancer modified radical mastectomy with fat grafting for breast reconstruction from January 2012 to March 2015 at Department of Body Contouring and Liposuction Center of Plastic Surgery,Hospital of Peking Union Medical College were analyzed retrospectively. The age of ：2：2 patients （all female ） was 28 to 54 years. Fifteen patients were performed breast modified radical mastectomy 5 to 16 year ago without radiotherapy, 7 patients were performed breast modified radical mastectomy following regular radiotherapy 2 years ago. Low negative pressure liposuction technical was applied to harvest fat tissue for 400 to 800 ml which was filtrated and purified by cotton pad method in low temperature environment. Fat grafting was performed with muhi- level and multi-tunnel and in muhi-point injection ways. All patients were followed up by regular imaging evaluation with MRI or uhrasonography after operation every 3 months. Results All breast reconstruction were successfully performed in 22 patients, no severe complications occurred. Among 15 patients without radiotherapy, 12 patients were performed with autologous fat grafting for breast reconstruction, 3 patients with prosthetic implantation for breast augmentation after autologous fat grafting. Among 7 patients with radiotherapy, 6 patients were performed with autologous fat grafting for breast reconstruction, 1 patient with prosthetic implantation for breast augmentation after autologous fat grafting. The volume of fat grafting was 104 to 380 ml. It took 2. 5 hours to finish the operation including 1.0 to 1.5 hours for liposuetion and 40 minutes for fat grafting. Next fat grafting were performed after 3 months. The fat of the breast were survived well detecting by MRI, only 1 patient had a cystic nodule which had been resected during nipple reconstruction. Uhrasonography screened several cystic nodules with the major axis of 0. 1 to 0. 2 cm in the breast, which couldn＇t be found by palpating in 18 patients. The patients were followed up for 18 to 36 months, the outcome were satisfactory. Conclusion Autologous fat grafting for breast reconstruction simplifies the operation program with satisfied results and avoids the complications of breast reconstruction with skin flap.