乳腺癌不保留或保留乳头乳晕复合体的乳房切除术后胸肌前假体+补片Ⅰ期乳房重建的临床应用

Clinical application of immediate prepectoral implant-based breast reconstruction with TiLoop Bra after skin-sparing or nipple-areola-complex-sparing mastectomy for breast cancer patients

目的探讨乳腺癌不保留或保留乳头乳晕复合体的乳房切除术后胸肌前假体+补片Ⅰ期乳房重建术的手术方法、早期安全性及美容学效果。方法回顾性分析2022年1—7月于四川大学华西医院行乳腺癌不保留或保留乳头乳晕复合体的乳房切除术后胸肌前假体+补片Ⅰ期乳房重建患者的临床资料,统计患者的手术时间、术中出血量、早期并发症,并采用Ueda评分及Harris评分评估其早期美容学效果。结果纳入患者23例,均为女性,平均年龄(39.0±6.8)岁。1例患者双侧乳房均为恶性肿瘤,其余患者均为单侧恶性肿瘤。6例患者术前接受新辅助化疗,新辅助化疗前彩色超声包块平均最大径(24.4±11.9)mm。平均手术时间(153.9±49.4)min,术中出血量(29.2±18.3)mL。术后临床分期:新辅助化疗后未见癌残余1例、0期3例、Ⅰ期10例、Ⅱ期6例、Ⅲ期3例。患者均获随访,中位随访时间4.8(3.0~9.2)个月。术后3个月内主要并发症2例(8.3%),其中1例手术切口裂开、1例术区出血;次要并发症4例(16.7%),其中2例手术切口裂开、2例手术部位感染。术后3个月Ueda评分优好率达82.6%,Harris评分优良率达87.0%。全组患者均未出现运动畸形、包膜挛缩、乳头乳晕坏死、皮瓣坏死、移植物丢失。随访期间未发现肿瘤复发或转移。结论在选择可靠患者的情况下,乳腺癌不保留或保留乳头乳晕复合体的乳房切除术后胸肌前假体+补片Ⅰ期乳房重建术后早期是安全的,具有良好的早期美容学效果,在符合适应证的患者中有广阔的应用空间,可作为常规手术进行推广。

Objective To explore the surgical technique and preliminary safety and aesthetics results of immediate prepectoral implant-based breast reconstruction(BR)with titanium-coated polypropylene mesh(TiLoop Bra)after skin-sparing mastectomy(SSM)or nipple-areola-complex-sparing mastectomy(NSM)for breast cancer patients.Methods The clinical data of consecutive patients who underwent immediate prepectoral implant-based BR with TiLoop Bra after SSM or NSM in West China Hospital from January to July 2022 were retrospectively analyzed.The operation time,intraoperative blood loss,early complication were collected.The preliminary aesthetics results were assessed with the Ueda score and Harris score.Results All the patients were female with a mean age of 39.0±6.8 years.One patient had bilateral breast malignant tumors,and the others had unilateral malignant tumors.Six patients received neoadjuvant chemotherapy before surgery.The mean diameter of the tumors was 24.4±11.9 mm under the color ultrasound before the neoadjuvant chemotherapy.The mean operation time was 153.9±49.4 min.The mean intraoperative blood loss was 29.2±18.3 mL.There were 3 patients with tumor stage 0,10 patients with stageⅠ,6 patients with stageⅡ,3 patients with stageⅢand 1 patient was found no residual cancer after neoadjuvant chemotherapy.All the patients were successfully followed up with a median follow-up time of 4.8(3.0-9.2)months.There were 2(8.3%)patients with major complications,including 1 wound dehiscence and 1 hematoma,and 4(16.7%)minor complications,including 2 wound dehiscence and 2 infection.The patients with excellent and good Ueda score and Harris score accounted for 82.6%and 87.0%,respectively.None of the patients had animation deformity,capsular contracture,nipple-areola or skin flaps necrosis,or implant loss.During the follow-up period,no local/regional recurrence or distant metastasis was found.Conclusion For selected reliable patients,immediate prepectoral implant-based BR with TiLoop Bra after SSM or NSM for breast cancer patients is safe and has good aesthetics results in the early postoperative period.It has broad application space in patients with suitable indications,and can be promoted as a routine operation.