保留皮肤或保留乳头、乳晕的乳腺癌改良根治术后扩展型背阔肌肌皮瓣即时乳房再造

目的探讨行保留皮肤或乳头、乳晕的乳腺癌改良根治术后应用扩展型背阔肌肌皮瓣即时乳房再造的疗效。方法30例乳腺癌患者中16例行保留皮肤乳腺癌改良根治术，14例行保留乳头乳晕乳腺癌改良根治术，术后即时切取包括背阔肌及其表面的脂肪和岛状皮肤、髂嵴上方脂肪、背阔肌前沿侧胸部脂肪和肩胛区脂肪构成扩展型背阔肌肌皮瓣，转移至胸壁再造乳房。结果30例即时乳房再造全部获得成功。切除乳房的组织量180～350ml（平均245ml），移植再造乳房的扩展型背阔肌肌皮瓣组织量210～440ml（平均265ml）。28例术后辅助化疗，5例辅助放疗。随访6～34个月（平均22个月），均生存，其中1例术后8个月骨转移，1例术后19个月腋窝胸壁局部复发。美容效果：优14例，良11例，一般3例，差2例。结论乳腺癌患者行保留皮肤或乳头乳晕改良根治术后应用扩展型背阔肌肌皮瓣即时乳房再造可获得足够的组织量，再造乳房形态良好，不影响乳腺癌的术后辅助治疗和远期疗效。

Immediate breast reconstruction with the extended latissimus dorsi musculocutaneous flap after skin-sparing or nipple-sparing modified radical mastectomy of breast cancer

Objective To study the therapeutic effects of immediate breast reconstruction using extended latissimus dorsi (ELD) musculocutaneous flap after the skin-sparing or nipple-sparing modified radical mastectomy.Methods The skin-sparing modified radical mastectomy was carried out in 16 patients and the nipple-sparing modified radical mastectomy in 14 patients.And then immediate breast reconstruction was performed with ELD musculocutaneous flap in all patients.Results All patients obtained the successful breast reconstruction.The resected tissue volumes of mastectomy were 180-350 ml(mean 245 ml) and the ELD musculocutaneous flap volumes for breast reconstruction were 210-440 ml(mean 265 ml).28 patients received adjuvant chemotherapy and 5 patients received adjuvant radiation therapy.All the patients were followed up for 6-34 months(mean 22 months),finding that all the patients survived.One patient had bone metastasis 8 months after operation and another one experienced recurrence of breast cancer in axillas 19 months after operation.There were 14 excellent cases,11 good cases,3 fair cases and 2 poor cases in the morphology of reconstructed breast.Conclusion ELD musculocutaneous flap can provide enough tissue for immediate breast reconstruction after the skin-sparing and nipple-sparing modified radical mastectomy in patients with breast cancer.The morphology of reconstructed breast is excellent.Immediate breast reconstruction should not influence adjuvant therapy and long-term therapeutic effect.