自体肋软骨在乳头乳晕再造中的应用体会

目的 探讨自体肋软骨在乳头乳晕再造术中的临床应用.方法 采用改良"箭头"皮瓣法行乳头再造,将预先埋植于皮下脂肪组织中的自体肋软骨雕刻成乳头支架,碎软骨颗粒埋植于乳晕处,模拟形成乳晕腺.自2007年1月至2010年10月,共施行乳头乳晕再造14例.结果 14例患者术后Ⅰ期全部成活,2例患者因再造乳头较对侧大而进行了二次修整.对14例患者随访6～12个月,再造乳头形态自然,突度好,触诊时有良好的乳头韧性,埋植软骨粒的乳晕皮肤触诊有质粒感,效果满意.结论 应用自体肋软骨模拟乳头乳晕腺,使再造的乳头、乳晕更加逼真.     

乳头乳晕再造术的研究进展

乳头乳晕再造术随着乳房再造术的增多而不断发展,从开始的游离乳头再造,到后来广泛应用的局部皮瓣法再造,乳头凸度回缩的问题一直都存在。近年来,应用自体或移植组织植入再造乳头可使乳头的凸度得以长期维持。植皮术再造乳晕存在色泽欠缺的问题,而文身术恰好弥补了这个问题。     

对偶双M形皮瓣法乳头再造术

目的 介绍一种持久、逼真的乳头再造方法.方法 应用对偶双M形皮瓣法对乳房再造术后患者行乳头再造术7例,均为二期手术,其中TRAM皮瓣乳房再造术后患者5例,背阔肌皮瓣乳房再造术后患者2例.结果 7例患者均取得满意的效果.术后随访3～12个月(平均8个月),再造乳头回缩率约20%～30%.结论 对偶双形皮瓣再造乳头外形逼真,远期乳头凸度维持良好,值得临床上推广应用.     

改良箭式皮瓣乳头再造术的临床疗效观察

目的探讨改良箭式皮瓣乳头再造术的临床疗效。方法收集2018年1月至2019年10月在南京市中医院甲乳外科住院接受改良箭式皮瓣乳头再造的患者10例,对再造乳头回缩率、患者满意度及局部皮瓣并发症发生率进行评价。结果10例患者手术时间为(15.10±1.52)min,范围为13~18 min。所有患者随访时间为(14.60±1.07)个月,范围为3~24个月。乳头高度回缩率为(28.53±3.02)%,范围为23.5%~33.2%。乳头直径回缩率为(8.92±1.05)%,范围为7.1%~10.5%。患者满意度为(97.90±1.60)%,范围为96%~100%。10例患者均未出现切口愈合不良、切口裂开、皮瓣坏死等并发症。结论改良箭头式皮瓣设计简便,操作简单,疗效满意,术后并发症发生率低。     

乳腺癌改良根治一期乳房再造术后近期并发症的探讨

目的:探讨乳腺癌根治一期乳房再造术后近期发生的并发症及其原因.方法:收集本院2006年2月～2007年12月32例乳腺癌改良根治一期乳房再造病例.全组病例行乳房改良根治术乳房再造方法:一期行单蒂下腹部横行腹直肌肌皮瓣(TRAM)移植术3例,背阔肌肌皮瓣移植和假体植入6例,单纯假体植入术12例,乳房扩张假体植入术11例.结果:中位随访时间14个月,1例乳房局部血肿,1例术后10个月发生腹部切口疝:边缘局部坏死7例,乳头乳晕发生部分坏死2例,其中1例皮瓣坏死范围大导致假体露出.并发症的总发生率34.4%(11/32).结论:乳腺癌行改良根治性手术一期乳房再造术后并发症发发生率较高.乳癌改良根治手术时,要注意皮瓣及乳头乳晕区切除的宽度和剥离皮瓣的厚度:移植皮瓣时要注意移植的肌肉组织血运是否完整和有无遗留的微小血管未结扎;乳房再造术仅植入扩张器者,因局部张力小,对皮瓣血运影响小,并发症发生率低.     

结合多种方法的乳头乳晕再造21例临床体会

目的 探讨对乳头乳晕缺失进行再造的有效处理方法.方法 自2008年6月至2011年1月,对21例乳头乳晕缺失患者进行治疗,其中15例为先天性乳头乳晕缺失,6例为乳腺癌行根治术后乳头乳晕缺失,均应用小阴唇黏膜瓣游离移植行乳晕再造,并同期行局部皮瓣推进法乳头成形,后期对乳头乳晕色泽欠满意区域行文刺着色改善.结果 应用小阴唇黏膜瓣游离移植结合同期行局部皮瓣推进法乳头成形,本组21例均无血肿、感染、乳头乳晕坏死等并发症发生.后期采用文刺法,对本组患者中再造的乳头及5例局部乳晕黏膜色泽欠理想区域进行文刺着色.术后均获随访6～21个月,平均随访14.4个月,乳头乳晕色泽良好,乳晕外观圆润,乳头挺拔,形状满意.结论 应用小阴唇黏膜瓣游离移植结合同期皮瓣推进法乳头成形,后期行文刺着色,术式安全、有效,能获得较持久的塑形效果.     

保留乳头乳晕复合体乳癌术后即时扩展型背阔肌肌皮瓣乳房再造

目的:探讨保留乳头乳晕复合体的乳腺癌改良根治术后行即时以扩展型背阔肌肌皮瓣行乳房再造的安全性和手术技巧。方法:28例早期乳腺癌患者行保留乳头乳晕复合体乳腺癌改良根治术,术后即刻使用扩展型背阔肌肌皮瓣再造乳房。术中改进:注意保护乳房皮肤的感觉神经、保留胸背神经及二级分支,采取皮瓣翻转法乳房塑型,行腋窝填塞和腋前皱襞的重建以及切取皮瓣的组织量大于切除的20%～50%腺体量等。结果:28例即时乳房再造全部获得成功。随访12～36个月,均生存,无局部复发,其中1例术后10个月骨转移,1例2年后肺转移;美学效果:优18例,良6例,一般2例,差2例;再造乳房皮肤的感觉、乳头的竖起功能存在,自然下垂,外形对称,腋窝饱满,患侧肢体运动范围较常规改良根治术明显增大。结论:对于选择合适的病例,保留乳头乳晕复合体的乳腺癌改良根治术后应用即时扩展型背阔肌肌皮瓣再造术安全、有效,术中几点合理的技术改进可以明显提高再造乳房的质量和自然度。     

改良的鱼尾状瓣法乳头再造术

目的:探讨改良的鱼尾状瓣法乳头再造术式。方法:定位新乳头位置后,采用改良的鱼尾状瓣法,设计二个不等长的皮瓣,长分别为2.0～2.5cm和1.5～2.0cm,其共有的蒂位于下方,分别掀起皮瓣,旋转交叉缝合,再造乳头。结果:应用6例共6侧乳头再造,切口愈合好,形态对称,效果满意。结论:改良的鱼尾状瓣法是乳头再造的理想术式之一。     

改良的乳晕去表皮双三角皮瓣填充支撑法治疗乳头内陷

目的 介绍一种改良的乳晕去表皮双三角皮瓣填充支撑法矫治乳头内陷的手术方法.方法 采用乳晕去表皮双三角皮瓣填充支撑法矫治乳头内陷时,将一侧皮瓣向乳头内翻转270°,以填充隆起乳头,然后将另一侧皮瓣翻转180°置于乳头基部,以支撑乳头和缩小乳头基底直径.结果 2001年至2006年8月,采用改良乳晕去表皮双三角皮瓣填充支撑法矫正先天性乳头内陷16例,术后随访2个月至3年,乳头内陷无复发,乳头感觉良好,外形满意.结论 改良的乳晕去表皮双三角皮瓣填充法操作简便,易于掌握,术后乳头血运、感觉良好,效果持久,不易复发,是矫正乳头内陷的一种较理想的手术方法.     

乳腺癌改良根治术后即刻乳房再造46例分析

目的 探讨乳腺癌改良根治术后即刻乳房再造的方法 和疗效.方法 自2007年1月至2010年1月,对46例单侧乳腺癌改良根治术后患者采取即刻背阔肌皮瓣联合硅凝胶假体置入乳房再造术.结果 所有患者的切口均愈合良好,转移皮瓣全部成活,其中有2例背部积液,2例乳头乳晕部分坏死.经6个月至3年随访,全部患者无肿瘤局部复发或远处转移,再造乳房无包膜挛缩,外形满意.结论 乳腺癌改良根治术后即刻乳房再造操作简单易行,效果明显,安全性高,成活率高,外形良好,提高了乳腺癌患者术后的生活质量,值得临床应用.     

Long-term follow-up of a modified Anton-Hartrampf nipple reconstruction

This study was performed to determine the degree of shrinkage over time in nipple projection after reconstruction. Nipple-areolar reconstruction was performed using the modified Anton-Hartrampf technique, and pigmentation was achieved with tattooing. This study looked at 28 consecutive patients with nipple reconstruction performed at The Milton S. Hershey Medical Center of the Penn State Geisinger Health Systems between September 1989 and November 1993. Two patients were lost to follow-up and 3 patients died of breast cancer. Thus, 23 patients and a total of 32 nipples were investigated. Initial measurements of nipple projection were taken 2 weeks postoperatively. Patients were followed an average of 38.7 months (range, 11-66 months). Ten patients (18 nipples) had tissue expansion and implantation for breast mound reconstruction. Thirteen patients (14 nipples) had autologous breast mound reconstruction. The mean decrease in projection of the tissue expansion and implantation group was 76.7+/-9.7%. The mean decrease in projection of the autologous reconstruction group was 64.3+/-12.1%. The mean decrease in projection for the entire group was 71.3+/-21.9%. Comparison between the two groups using a two-sample t-test showed p = 0.0047. The authors concluded that there is a significant reduction in nipple projection over time using the modified Anton-Hartrampf technique regardless of the type of breast mound reconstruction. In addition, their results also indicated that nipple projection on the breast mound reconstructed with an autologous musculocutaneous flap technique achieved a better long-term outcome. This study is potentially helpful in planning the initial size of the reconstructed nipple papule to match the opposite normal nipple. Additional studies need to be performed on other types of nipple-areolar reconstruction.     

Nipple projection evolution using the modified arrow flap: prospective study on 25 consecutive nipple reconstructions

Background

Nipple–areola complex reconstruction represents the final stage of breast reconstruction. It is considered one of the most important landmarks of the entire process. It is known that nipples reconstructed with local flaps slowly and inexorably flatten with time. The authors undertook this prospective study to evaluate the effectiveness of a modified arrow flap technique for nipple reconstruction.

Methods

A series of 25 consecutive nipple reconstructions were performed on post-mastectomy defects reconstructed with tissue expander and implant or autologous tissues. All patients have been followed for at least 12 months, and the involution of the nipple projection was assessed through digital caliper measuring.

Results

No immediate complications were observed. The average immediate postoperative projection was 12.9 mm. The average residual projection at 3, 6, and 12 months was 69, 47, and 35 %, respectively.

Conclusions

The modified arrow flap has proved to have an acceptable residual projection with pleasing clinical outcome. It is a reliable procedure, easy to learn, and reproduce. Level of Evidence: Level IV, therapeutic study.     

Use of lyophilized allogeneic costal cartilage: is it effective to maintain the projection of the reconstructed nipple?

The maintenance of adequate projection is one of the most important aspects in nipple reconstruction. A total of 17 nipples were reconstructed using the modified top hat flap technique with lyophilized allogeneic costal cartilage, and patients were followed up for 1 year. Projection at 6 months and 1 year was compared with the immediate postoperative result, as well as with the results of nipples reconstructed without cartilage. After 6 months and 1 year, there were significant reductions in projection, with the average losses of 51.7% and 57.7%, respectively. There were no significant differences between groups with or without cartilage. These findings show that nipples reconstructed with lyophilized allogeneic cartilage beneath the modified top hat flap showed no benefit compared with nipples reconstructed without cartilage.     

Nipple reconstruction in Asian females using banked cartilage graft and modified top hat flap.

Nipple reconstruction is usually the final stage of breast reconstruction and there are over 50 articles that describe different techniques. The majority of methods use local soft tissue as local flaps but they face the disadvantage of reduction in nipple projection after the initial two months. This is particularly troublesome in Asian females who may have wider nipples with prominent projection but small areola surface area. We developed a method to correct this problem using cartilage graft harvested during the initial breast reconstruction operation and banked beneath the skin flap. Using the modified 'top hat' flap, we found that no excess soft tissue is required to compensate for the reduction. We have used this method in 25 cases of nipple reconstruction and have obtained satisfactory result in projection.     

Improving long-term projection in nipple reconstruction using human acellular dermal matrix: an animal model

Reconstructed nipples rapidly lose projection. We describe the use of human acellular dermal matrix (ADM) to improve long-term projection of nipple flaps. Athymic rats were randomized to 3 groups; each received 2 nipples: bell flap (control, n = 16 nipples), bell flap with a cylinder of implanted ADM (n = 24), or bell flap with intraflap injection of micronized ADM (MADM) (n = 10). Seven of 24 ADM nipples extruded (30%). By 12 weeks, the control nipples maintained 44% of initial projection compared with 70% for ADM nipples (P = 0.000025). The MADM nipples maintained 49% of initial projection after 12 weeks (P = 0.55 compared with control). No MADM nipples extruded. ADM grafts maintain long-term projection better than local tissue flaps alone. We hypothesize that MADM may limit extrusion and allow for serial injection of nipples. Based on the promising results of this study, clinical trials are warranted using human ADM and/or human MADM for nipple reconstruction.     

A modified technique for nipple-areola complex reconstruction

Background:

From a historical perspective, many techniques of nipple reconstruction have been performed, including a graft from the contralateral nipple, composite grafts such as toe pulp or earlobe tissue and even an intra-dermal tattoo alone. This is the final stage of breast reconstruction, and is carried out only when the surgeon is confident that acceptable symmetry and shape of the reconstructed breast has been achieved. The technical challenges of nipple reconstruction include correcting position, maintaining adequate projection and creating an inconspicuous scar. An alternative to a surgically reconstructed nipple is the use of silicone prosthetic nipples.

Materials and Methods:

From August 2006 until September 2007, 80 cases of nipple/areola reconstruction were performed in our department (UDINE UNIV.) following mammary reconstruction or conservative breast surgery. Forty cases were carried out with the classical technique and another 40 cases with the introduction of our modification in the form of deepithelization of a semicircular area of the adjacent skin at the base of the flap. Postoperative follow-up as regards the nipple size, site, projection, symmetry and donnar scar were assessed. Patient satisfaction was also addressed and evaluated.

Results:

There were good to excellent results as regards nipple size, symmetry and projection. The technique is suitable for different autologous and implant reconstruction. The technique is an outpatient procedure, is easy and is not consuming time. Areolar graft from the contra-lateral areola is colouur matching and shows nearly no deference from the opposite one.

Conclusions:

Simple technique and not time consuming. Maintains the consistency and projection of the new nipple. Patient satisfaction. Minimal complication.     

Simultaneous Nipple and Areola Reconstruction: A Review of 50 Cases

Nipple areola complex reconstruction has historically been a staged procedure, the nipple being reconstructed first by graft or local flap techniques and the areola on a later procedure to gain colour. This paper presents a one-stage combined reconstruction procedure using a local flap and immediate areola tattoo: it presents the advantage of reducing the total number of needed procedures and subsequently diminishes the total time needed to obtain a complete result. In this series of 50 consecutive combined procedures with a mean follow-up of ten months, no necrosis of reconstructed nipple was observed and a total of six patients needed minor revision surgery to correct nipple projection or fading of the tattoo. No local infection or wound complications were observed, underlying the safety of the procedure. Patient satisfaction and compliance were good because the procedure is fast and easy with minimal morbidity.     

Filler Injection Enhances the Projection of the Reconstructed Nipple:An Original Easy Technique

Background Reduced nipple projection is the main reason for unsatisfactory nipple–areola complex reconstruction, and many techniques have been proposed to maintain projection of the reconstructed nipple.Methods For 70 patients, 90 nipples were reconstructed using either a small wedge from the labia minora (LMW) (n=70) or nipple sharing (NS) (n=20). Two months after reconstruction, each reconstructed nipple was injected with DermaLive. Second and third injections were performed 2 and 5 months later. The injected volume was tailored to the desired projection. Nipple projection was measured at the moment of implant, before and after each injection, and 6 and 12 months after the last injection.Results Nipple projection was satisfactory in all cases and comparable with that of the contralateral nipple. The average nipple projection at 6 months was 5.8 mm in the LMW group and 3.8 mm in the NS group (p < 0.01) and, respectively, 5.6 mm and 3.5 mm at 12 months (p < 0.01). No complications occurred, except for one positron emission tomography (PET) false-positive result.Conclusions The described method is simple and safe. It provides precise projection with no need for intraoperative forecasting of tissue reabsorption. The result was better for the LMW patients, perhaps because of their higher distensibility.     

A modified technique for nipple reconstruction: the 'arrow flap'.

It is well known that nipples reconstructed using local tissue flaps slowly flatten. Furthermore, patients with implant reconstruction show the highest amount of nipple projection loss. This article describes some modifications to the technique proposed by Thomas et al in order to maintain flap projection. We undertook a prospective study to evaluate the effectiveness of our technique, named 'arrow flap'. We compared a series of patients with unilateral breast reconstruction (16 implants, 16 TRAM flaps) who underwent nipple reconstruction using either the 'modified star flap' or the 'arrow flap'. The statistical significance of the results was determined by Student's t test. The arrow flap proved to have a higher residual projection and these results were statistically significant. Furthermore, it has been equally useful on implant and autologous reconstructions. This technique is easy to learn and to perform. The procedure is reliable and patient satisfaction and compliance are very good.     

Simultaneous nipple and areola reconstruction: a review of 50 cases

Nipple areola complex reconstruction has historically been a staged procedure, the nipple being reconstructed first by graft or local flap techniques and the areola on a later procedure to gain colour. This paper presents a one-stage combined reconstruction procedure using a local flap and immediate areola tattoo: it presents the advantage of reducing the total number of needed procedures and subsequently diminishes the total time needed to obtain a complete result. In this series of 50 consecutive combined procedures with a mean follow-up of ten months, no necrosis of reconstructed nipple was observed and a total of six patients needed minor revision surgery to correct nipple projection or fading of the tattoo. No local infection or wound complications were observed, underlying the safety of the procedure. Patient satisfaction and compliance were good because the procedure is fast and easy with minimal morbidity.