硅凝胶乳房假体联合钛网补片在早期乳腺癌即刻乳房重建中的应用

Application of silicone gel breast prosthesis combined with titanium polypropylene mesh in immediate breast reconstruction for early breast cancer

目的 探讨硅凝胶乳房假体联合钛网补片在早期乳腺癌术后即刻乳房重建中的应用效果。方法 收集2018年3月至2021年5月在我院行保留乳头乳晕复合体乳房切除(NSM)术,并采用硅凝胶乳房假体联合钛网补片即刻乳房重建的42例早期乳腺癌患者的临床资料,分析手术状况、术后并发症、重建乳房美学效果和远期随访结果。结果 42例患者均顺利完成手术,手术时间(139.36±2.87) min、术中出血量(85.76±4.23) mL、总引流量(1 262.53±17.65) mL、拔管时间(9.61±2.67) d。术后乳头乳晕复合体(NAC)缺血发生率11.90%(5/42),切口感染/愈合不良发生率4.76%(2/42),血清肿发生率2.38%(1/42);本组患者术后无假体移位、外露、丢失,但4例(9.52%,4/42)出现轻度包膜挛缩。重建乳房美学效果与患者BMI和乳房下垂度有关,正常BMI和乳房无/轻度下垂者,假体重建乳房的美学效果更好;重建乳房优良率达83.33%(35/42)。随访3~37个月,未发生肿瘤复发或远处转移。结论 选择合适的早期乳腺癌患者,NSM术后采用硅凝胶乳房假体联合钛网补片行即刻乳房重建,近期肿瘤安全性和重建乳房美学效果确切,值得临床推广。

Objective To explore the application effect of silicone gel breast prosthesis combined with titanium mesh patch in immediate breast reconstruction for early breast cancer(EBC). Methods From March 2018 to May 2021, 42patients with EBC who underwent breast reconstruction with silicone gel breast prosthesis and titanium mesh patch after nipple-areola complex sparing mastectomy(NSM) were retrospectively analyzed. The intraoperative conditions, postoperative complications, breast aesthetic effect and long-term follow-up results were analyzed. Results All 42 patients completed the operation successfully, and the operative time was(139.36±2.87) min, the intraoperative blood loss was(85.76±4.23) mL, the total drainage volume was(1 262.53±17.65) mL, and the extubation time was(9.61±2.67) days. The incidence of postoperative NAC ischemia was 11.90%(5/42), the incidence of wound infection/poor healing was 4.76%(2/42), and the incidence of seroma was 2.38%(1/42). There was no postoperative implant displacement/exposure/loss, but 4 cases(9.52%, 4/42) showed mild capsular contracture. The aesthetic effect of breast reconstruction was related to patients’ BMI and breast ptosis. For patients with normal BMI and no/mild breast ptosis, the aesthetic effect of breast reconstruction was good, and the excellent rate of breast reconstruction in 42 patients was 83.33%(35/42). No tumor recurrence or distant metastasis was observed during 3-37 months of follow-up. Conclusion For appropriate patients with early breast cancer, silicone gel breast implant combined with titanium mesh patch for immediately breast reconstruction after NSM is feasible, the near-term tumor safety and the aesthetic effect of breast reconstruction are accurate, and it is worthy of clinical promotion.