星状皮瓣结合乳房真皮脂肪瓣乳头再造及乳房下皱襞重建的临床观察

Clinical observation of fat-graft reconstruction by a novel “star flap” and inframammary fold recreation by liposuction

目的评价星状皮瓣联合游离脂肪瓣乳头再造及乳房下皱襞(inframammary fold reconstruction,IMF)重建的手术效果。方法自2017年8月至2018年12月,31例就诊于中国医学科学院整形外科医院患者,均为乳腺癌术后单侧乳房全切、全乳缺失伴乳头缺失,已接受自体脂肪移植重塑乳房者。研究组共19例,患者使用星状皮瓣结合乳房真皮脂肪瓣法再造乳头、联合IMF抽吸成型术同期进行下皱襞重建。对照组共12例,单纯行自体脂肪移植乳房再造术,未行乳头及乳房下皱襞再造。研究组分别于术后7 d、3个月、6个月对手术安全性及术后效果进行评价。术后6个月,统计两组患者满意度评估结果,进行统计学分析。结果所有患者术区恢复良好,切口愈合不良1例,未发现乳头坏死。术后6个月,患者乳头大小及位置与健侧对称,乳房形态改观明显,轮廓自然美观与健侧对称性良好。研究组患者满意度等级(非常满意、满意、基本满意、不满意、非常不满意)为:26.3%、52.6%、22.9%、5.3%、0%;对照组满意度等级分别为:0%、18.1%、45.5%、36.4%、8.3%,(Z=3.451,P=0.01),两组的满意效果差异有统计学意义。结论星状皮瓣结合乳房真皮脂肪瓣法联合IMF重建术,设计方法简便,术中易于操作,术后美观度好,可显著提高患者满意度,值得临床应用推广。

Objective To evaluate aesthetic outcomes of nipple reconstruction by a novel designed "star flap" in breast reconstruction with free fat graft after total mastectomy and contribution of an inframammary fold recreation by liposuction to breast shape improvement.Methods From August 2017 to December 2018,31 patients,present spontaneously to Plastic Surgery Hospital,Chinese Academy of Medical Sciences,who suffered from breast cancer and received unilateral or total mastectomy were included in this study.After breast reconstruction with autologous fat transplantation,a local star shaped flap was raised.There were 19 cases in the study group.Rolled free dermal-fat matrix harvested subcutaneously from reconstructed breast was implanted within the core of flap.Meanwhile,an inframammary fold was reconstructed by local liposuction.In the control group,12 patients were randomly selected for breast reconstruction with autologous fat transplantation alone,without nipple and submammary fold reconstruction.At 7 days,3 months and 6 months after reconstruction,the safety and effect was conducted to evaluate the efficacy of the outcomes.Results All patients who received nipple and inframammary fold reconstruction recovered well after surgery.Among them,1 case had poor wound healing,respectively,after operation no nipple necrosis was found.Position of the reconstructed nipple were symmetrical with the contralateral side Shrinkage of the nipple projection was continuously observed,which resulted a more nature projection after 6 months.The degree of satisfaction(very satisfactory,satisfied,basically satisfied,unsatisfactory,very unsatisfactory) in the study group was 26.3%,52.6%,22.9%,5.3%and 0%,respectively,while that in the control group was 0%,18.1%,45.5%,36.4%,8.3%,(Z=3.451,P=0.01).There wasstatistical difference in the distribution of satisfaction effect between the two groups.Conclusion The star flap buried with dermal-fat plug showed good postoperatively.In combined with inframammary fold recreation with liposuction,the design method is simple,easy to manipulate during the operation,and has good aesthetic quality after the operation.It can significantly improve patient satisfaction and is worthy of clinical application and promotion.