腹壁下动脉穿支皮瓣联合胸壁皮瓣同期再造乳房和乳头

Immediate nipple reconstruction with a local mastectomy flap following secondary DIEP flap breast reconstruction

目的探讨腹壁下动脉穿支皮瓣联合胸壁皮瓣同期再造乳房和乳头的临床效果。方法切取游离的双侧腹壁下动脉穿支皮瓣，向上折叠对合进行乳房重建。同时，在患侧胸壁切取远端携带皮岛的去表皮局部皮瓣，穿过再造乳房，并将皮岛固定于拟再造乳头位置。3周后胸壁皮瓣断蒂，将皮岛重塑成乳头形态。结果2011年2月至2016年6月，应用该方法对42例单侧乳腺癌改良根治术后患者进行乳房和乳头重建，所有皮瓣均成活良好，术后即刻再造乳头高度为（16.3±2.4） mm，1年后高度降低至（8.4±1.3） mm。其中35例患者对再造乳房和乳头表示非常满意或满意。结论腹壁下动脉穿支皮瓣联合胸壁皮瓣进行乳房和乳头再造，可获得较好的乳房形态，乳头能维持足够的高度，患者满意度较高。

ObjectiveTo investigate the clinical effects of immediate nipple reconstruction with a local mastectomy flap in secondary breast reconstruction by deep inferior epigastric artery perforator （DIEP） flap.MethodsA free bipedicle DIEP flap was raised and folded upward to form the breast. Meanwhile, a deepithelialized lower mastectomy flap with a distant skin paddle was elevated and pulled throughout the reconstructed breast. The skin paddle was carefully sutured to the position of future nipple. Three weeks later, the pedicle of mastectomy flap was divided, and the paddle was modeled to form the new nipple.ResultsFrom February 2011 to June 2016, 42 patients who had previously undergone unilateral modified mastectomies underwent the breast reconstructions and immediate nipple reconstructions. All flaps survived postoperatively. The average projection of the reconstructed nipple was measured as （16.3±2.4） mm immediately after the operation and gradually decreased to （8.4±1.3） mm by one year follow up. 35 patients ranked the aesthetic appearance of the reconstructed nipple and breast very good or good.ConclusionsThe immediate nipple reconstruction with a local mastectomy flap and breast reconstruction by DIEP flap could achieve a good breast shape and maintain a long term residual nipple projection, which results in considerable patient satisfaction.