Single-Stage Reconstruction of Skin-involving Nasal Paraffinoma with Pericraniosubgaleal Flap

Background  

The removal of a paraffinoma over the nasal bridge may result in thinning and even loss of involved skin as well as a saddle nose deformity. For nasal reconstruction, a variety of techniques using a free graft of autogenous tissue such as fascia, dermofat, or cartilage have been used, either in immediate, single-stage or in delayed, multiphase treatment. However, such reconstructions can be challenging largely due to absorption of the grafted tissue and poor blood supply to the surrounding nasal tissue infiltrated with paraffin. This article reports the successful clinical outcomes of immediate, single-stage reconstructions by wrapping a pericraniosubgaleal flap over the nasal implant after removing a paraffinoma.     

One stage placement of permanent implant compared to two stage tissue expander reconstruction

With the advent of the skin sparing mastectomy, immediate breast reconstruction with placement of the definitive prosthesis at the time of mastectomy is possible. The question remains: does single-stage prosthetic reconstruction result in greater numbers of complications or rates of re-operation, compared to two-stage tissue expander reconstruction? A retrospective cohort study of a single centre?s experience with these techniques was carried out. From 2004 to 2012, 54 cases of immediate breast reconstruction with implant were identified, and 108 cases of immediate breast reconstruction using a tissue expander were identified. Gathered preoperative data included tumour, prior exposure to radiation, preoperative chemotherapy, smoking, and comorbidities. Complication rates, as well as the rate of secondary operations, were examined. There were no significant increased risks in the rate of post-operative complications (p?=?.910, odds ratio?=?0.9) nor in the rate of re-operation (p?=?0.421, odds ratio?=?1.4) associated with the insertion of a definitive prosthesis at the time of skin sparing mastectomy. However, previously radiated breasts experienced a 100% rate of wound complications in our subset of 9 breasts that underwent one stage breast reconstruction with immediate final prosthesis placement. Our study suggests that patients with early stage disease can undergo single stage breast reconstruction without increased risk of complications nor need for secondary operations. While the mean time to completion of the reconstructive process is shortened by 5 months with the single stage technique, implant based breast reconstruction requires careful counseling and patient selection in radiated patients.     

Update on one-stage immediate breast reconstruction with definitive prosthesis after sparing mastectomies

Immediate breast reconstruction after skin and nipple-sparing mastectomies is commonly performed as a two-stage procedure; to overcome the paradox of traditional two-stage tissue expander/implant reconstruction used to create a tight muscular pocket that needs expansion to produce lower pole fullness, while losing the laxity of the mastectomy skin flaps, the authors conceived a subpectoral-subfascial pocket by elevating the major pectoral muscle in continuity with the superficial pectoralis fascia up to the inframammary fold. This alteration allowed for the immediate insertion of the definitive implant.The authors present their experience in 220 cases of immediate one-stage breast reconstructions with definitive prostheses in sparing mastectomies. Immediate and long-term local complications were evaluated. Immediate breast reconstruction with definitive anatomical silicone-filled implants can produce excellent cosmetic results (78.6%) with a low rate of complications (17.7%); these results allow for agreement between oncologic, aesthetic and economic purposes.     

Delayed‐immediate hybrid breast reconstruction—Increasing patient input and precision in breast reconstruction

The benefits of breast reconstruction via free tissue transfer with simultaneous implant placement, that is, hybrid breast reconstruction, in select patients are well‐known. Challenges exist, however, and are related to proper implant selection as well as postoperative mastectomy skin necrosis. Here, the authors present an approach that increases reconstructive precision while minimizing postoperative mastectomy skin necrosis. A retrospective analysis of patients who underwent immediate prepectoral tissue expander placement (stage 1) followed by delayed‐immediate hybrid breast reconstruction (stage 2) was performed. Parameters of interest included patient demographics, postoperative complications, and revision rates. A total of 31 patients with a mean age of 48.7 years (range, 30‐67 years) and a mean BMI of 26.3 kg/m² (range, 21.0‐35.3 kg/m²) who underwent bilateral breast reconstruction were included. Of the 62 free abdominal flaps, 45 (72.6%) and 17 (27.4%) were MS‐TRAM and DIEP flaps, respectively. The most common implant volume was 240 cc (range, 140‐445 cc). Following stage 1, minor and major complications were observed in nine (29%) and one (3.2%) patients, respectively. No major complications were noted after stage 2. Of note, no patient developed mastectomy skin necrosis or requested a change in implant size following stage 2. Delayed‐immediate hybrid breast reconstruction improves the ability to more precisely match patient expectations related to breast size and is associated with a reduction in the rate of mastectomy skin necrosis following the critical second stage of reconstruction.     

Paraffinomas of the breast or oleogranulomatous mastitis-a rare entity

Breast augmentation with the injection of a high-viscosity fluid has been practiced in the past, especially in Asia, resulting in most cases in different varieties of paraffinoma, alternatively known as oleogranulomatous mastitis, a complication of a 'foreign body' reaction type. We report our series of four consecutive cases of destructive paraffinomas that occurred in female patients who had had paraffin injection for cosmetic reasons. Complications due to paraffinoma reactions of breast tissue and skin, as well as progression of the disease and treatment of our patients, are presented here, together with a review of the relevant literature.     

即刻及延期乳房再造方法的选择

目的回顾总结乳腺癌根治术后应用单纯假体植入、Becker可扩张假体植入和单蒂腹部横形腹直肌肌皮瓣（TRAM）移植、扩大背阔肌肌皮瓣（ELDF）移植乳房再造术的经验,探讨手术的适应证、方法和效果。方法自2002年7月至2005年10月,共67例患者进行了乳腺癌根治术后乳房再造术。即刻乳房再造56例：单纯假体植入38例、Becker可扩张假体植入16例、单蒂TRAM移植2例。延期乳房再造11例：单蒂TRAM移植6例、ELDF移植4例、Becker可扩张假体植入1例。结果手术效果满意,优良率超过90％。5例患者出现轻微并发症：皮瓣局灶性坏死2例,保留的乳头乳晕部分坏死1例,血清肿2例。结论单纯假体植入用于即刻乳房再造,适用于乳房较小、行保留皮肤的乳腺癌根治术后的患者,不宜用于延期乳房再造;可扩张假体植入即刻乳房再造适用于乳房较大或改良乳腺癌根治术的患者,同时可扩张假体植入延期乳房再造可用于皮肤、肌肉保留较好的乳腺癌根治患者;TRAM和ELDF皮瓣移植乳房再造是自体组织移植,其安全性高,可用于即刻和延期乳房再造。     

Nonexpansive immediate breast reconstruction using human acellular tissue matrix graft (AlloDerm)

Immediate breast reconstruction has become a standard of care following mastectomy for cancer, largely due to improved esthetic and psychologic outcomes achieved with this technique. However, the current historical standards--transverse rectus abdominis myocutaneous flap reconstruction and expander--implant surgery-still have limitations as regards patient morbidity, short-term body-image improvements, and even cost. To address these shortcomings, we employ a novel concept of human tissue replacement to enhance breast shape and provide total coverage, enabling immediate mound reconstruction without the need for breast expansion prior to permanent implant placement. AlloDerm (human acellular tissue matrix) is a human-derived graft tissue with extensive experience in various settings of skin and soft tissue replacement surgery. This report describes the success using acellular tissue matrix to provide total coverage over the prosthesis in immediate reconstruction, with limited muscle dissection. In this population, 49 patients (76 breasts) successfully underwent the acellular tissue matrix-based immediate reconstruction, resulting in durable breast reconstruction with good symmetry. These findings may predict that acellular tissue matrix-supplemented immediate breast reconstruction will become a new technique for the immediate reconstruction of the postmastectomy breast.     

Skin-sparing mastectomy flap complications after breast reconstruction: review of incidence,management, and outcome

This study assesses the incidence and outcome of skin-sparing mastectomy (SSM) flap complications after breast reconstruction. The authors performed a retrospective review of 37 consecutive patients undergoing SSM and immediate breast reconstruction, focusing on preoperative demographics, management of complications, and early outcome. Univariate analysis comparing patients with and without complications was performed using Student's t-test and chi-square analysis. From July 2000 to December 2001, 37 patients (mean age 48.1, range 24-71 y) underwent SSM and breast reconstruction (unilateral 20, bilateral 17) via TRAM flaps (n = 18), latissimus flaps (n = 13), and expander/implants (n = 6). SSM flap complications occurred in nine patients (24.3%) and included mild (n = 2), moderate (n = 5), and severe (n = 2) skin loss, resulting in four cases of dehiscence, five reoperations, and no delay in postoperative adjuvant therapy (required in six patients). Previous irradiation (n = 5, p = 0.045) and diabetes (n = 3, p = 0.001) were associated with SSM flap complications, but age, smoking, previous breast cancer, and type of reconstruction were not. Patients with SSM flap loss had a higher body mass index (BMI) than those without complications (30.0 vs. 24.3; p = 0.025). Skin flap complications after SSM and breast reconstruction are not uncommon but did not delay the initiation of adjuvant chemotherapy or radiotherapy, despite the need for reoperation. Patients with elevated BMI, diabetes, and previous irradiation may be at increased risk for SSM flap complications.     

几种乳房再造术的临床应用体会

目的：探讨乳腺癌根治术后应用单纯假体植入、可扩张假体植入和带蒂腹部横形腹直肌肌皮瓣（TRAM）移植乳房再造的适应证、手术方法、手术效果。方法：本组共24例病例。14例乳腺癌患者行保留皮肤的乳腺癌根治术，Ⅰ期行假体植入乳房再造；6例采用改良乳腺癌根治可扩张假体植入Ⅰ期乳房再造；4例接受单蒂下腹部横形腹直肌肌皮瓣（TRAM）移植乳房再造手术，其中2例为Ⅰ期再造，另2例为Ⅱ期乳房再造。结果：手术效果较满意，2例出现轻微并发症，其中1例皮瓣局灶坏死，另1例出现乳头乳晕部分坏死。结论：单纯假体植入适用于乳房小，没有明显下垂的瘦小病人。优点是不增加额外瘢痕，术后恢复快；可扩张假体植入乳房再造适用于乳房大或改良乳腺癌根治术的患者，此法结合了单纯假体植入法和组织扩张的优点：TRAM皮瓣移植乳房再造的优点是自体组织移植，安全、手术效果好。     

乳腺癌保留皮肤改良根治并即刻假体再造与传统改良根治术的疗效比较

目的 比较乳腺癌保留皮肤改良根治并即刻假体再造和传统改良根治术的治疗效果.方法 对2004年1月至2008年12月手术治疗的530例0～Ⅲa期女性乳腺癌患者病例资料进行回顾性分析.530例中,91例行乳腺癌保留皮肤改良根治并即刻假体再造,439例行传统改良根治术.通过比较两组患者术后并发症、局部复发率、远处转移率、病死率的差异,评价乳腺癌保留皮肤改良根治并即刻假体重建与传统改良根治术的疗效.结果 即刻假体再造组随访患者84例,中位随访时间35个月,局部复发率2.4%,远处转移率8.3%,病死率6.0%;改良根治组随访患者439例,中位随访时间36个月,局部复发率3.3%,远处转移率9.5%,病死率6.5%.随访期间两组复发率、转移率、病死率的差异均无统计学意义(P＞0.05).即刻假体再造组术后美观效果随访12个月,医生和患者评估的良好率分别为93%、87%.结论 乳腺癌保留皮肤改良根治并即刻假体再造可以达到和传统改良根治术相当的疗效,并可显著改善患者术后乳房外形美观及生活质量.

Abstract：

Objective To compare the therapy efficiency of immediate implanting breast reconstruction after skin sparing mastectomy and modified radical mastectomy in breast cancer. Methods The data of 530 female patients with early of stage 0 to Ⅲ a breast cancer was retrospectively analyzed, from January 2004 to Decembet 2008. Among the patients,91 patients operated with skin sparing mastectomy and immediate implanting breast reconstruction ( Group of immediate implanting reconstruction), and 439 patients were with modified radical mastectomy (Group of modified radical mastectomy ). By comparing complications, local recurrence, distant metastases and mortality rates between the two groups, the research was done to evaluate the therapy efficiency. Results In the group of immediate implanting reconstruction,84 patients completed follow-up with the median follow-up time of 35 months ( 14-72 months) while the local recurring rate was 2. 4%, distant metastasis rate was 8. 3% and mortality rate was 6. 0%. In the group of modified radical mastectomy, 398 patients completed follow-up with the median follow-up time of 36 months ( 12-74 months) while the local recurring rate was 3.3%, distant metastasis rate was 9. 5% and mortality rate was 6. 5%. Therefore there was no obvious statistic difference between the two groups in local recurring rate, distant metastasis rate and mortality rate (P ＞ 0. 05 ). Evaluation of aesthetic results was done in the 84 patients after immediate implanting reconstruction for 12 months which was 93% as good or excellent by surgeons while 87% by patients. Surgeons and patients were both satisfied with the breast appearance. Conclusions For patients with early stage breast cancer, combining standard postoperative therapy, skin sparing mastectomy and immediate implanting reconstruction could achieve the same effect as the traditional modified radical mastectomy, while reconstruction would bring about better appearance and higher quality of life.     

乳腺癌切除术后乳房再造

目的 探讨乳腺癌切除术后乳房再造的方法及时间.方法 总结30例不符合保乳条件的乳腺癌病例,乳房切除术后假体置人乳房再造16例,下腹部横行腹直肌肌皮瓣(TRAM瓣)乳房再造10例,背阔肌肌皮瓣乳房再造4例.其中即刻乳房再造27例,延期乳房再造3例.结果 16例假体置入乳房再造术后外观评价均为良,未出现术后并发症.10例TRAM瓣乳房再造术后发生皮瓣部分坏死2例,腹壁疝1例,术后外观评价7例为良.2例为较好,1例为差.4例背阔肌肌皮瓣再造术后外观评价为良.结论 乳房再造术是乳腺癌综合治疗不可忽视一部分,对于有强烈的保乳愿望,而又不符合保乳条件的患者,乳房再造术是一种较好的选择.即刻乳房再造优于延迟乳房再造.乳房再造的方法选择要因人而异.局部晚期乳腺癌患者可以选择性进行即刻乳房再造术.     

Breast reconstruction with pedicled TRAM flap (a retrospective study of 115 consecutive cases)

Purpose of the study

The purpose of this study is to analyse the advantages, disadvantages and results of the unipediculed TRAM flap.

Patients and method

This retrospective study concerns 115 consecutive unipediculed TRAM flaps realised by two surgeons between 1994 and January 2007. These reconstructions were all realised for oncologic pathology and were either immediate or delayed surgery. Concerning the immediate reconstruction, a skin sparing mastectomy has been realised as often as possible for intraductal carcinomas and small invasive carcinomas. For the immediate reconstruction the study takes into account complications and oncologic recurrences with an average backward of 45 months.

Results

The unipediculed TRAM flap offers a good reliability and the esthetics results are stable at long-term for immediate breast reconstruction and delayed breast reconstruction. The major complications are flap necrosis (12,2%) and parietal complications (6%). The recurrence rate after mastectomy and unipediculed TRAM flap is equivalent of the recurrence rate expected for mastectomy alone. There were never late diagnostic for recurrence after unipediculed TRAM flap. The esthetic improvement by surgery concerns the opposite breast for 31,3%, it was a mastopexy or reduction. The esthetic improvement of the TRAM flap concerns 14 patients (12,1%). The improvement of inframammary crease was the most frequent improvement (9/115–8%).

Conclusion

The TRAM flap unipediculed allows a delayed, immediate breast reconstruction or bilateral synchronised breast reconstruction. The long-term disadvantages are the abdominal complications and the impossibility to realise the same technique for a later controlateral reconstruction.     

Skin-sparing mastectomy

The cosmetic appearance of the reconstructed breast is largely dependent upon the quantity of breast skin which remains after mastectomy. Leaving behind as much skin as is possible significantly improves the natural appearance of the reconstruction and reduces procedures required on the contralateral breast to achieve symmetry. SSM with immediate reconstruction offers superior aesthetic results to NSSM, with similar LR rates. As most recurrences will occur in chest wall skin, the ability to detect local recurrence is not impaired. The incidence of local wound complications with SSM is comparable to NSSM. It has been demonstrated that sentinel lymph node biopsy and axillary dissection can be performed adequately in SSM. There is no contraindication to postoperative adjuvant chemotherapy and radiation therapy. There are some groups of patients for whom SSM is not indicated, such as patients with inflammatory carcinoma. SSM should be considered for selected patients with breast cancer in conjunction with all types of immediate reconstruction. In conclusion, numerous studies support the use of SSM on selected patients as an oncologically acceptable procedure with superior cosmetic results when compared with traditional NSSM.     

Oncological results in women with wound complications following mastectomy and immediate breast reconstruction: A meta-analysis

We performed a meta-analysis to evaluate the oncological results in women with wound complications following mastectomy and immediate breast reconstruction. A systematic literature search up to August 2022 was performed and 1618 subjects with mastectomy and immediate breast reconstruction at the baseline of the studies; 443 of them were with wound complications, and 1175 were with no wound complications as a control. Odds ratio (OR) and mean difference (MD) with 95% confidence intervals (CIs) were calculated to assess the oncological results in women with wound complications following mastectomy and immediate breast reconstruction using dichotomous or contentious methods with a random or fixed-effect model. The wound complications had a significantly longer length of time to adjuvant therapy (MD, 9.44; 95% CI, 4.07–14.82, P < .001) compared with no wound complications in subjects with mastectomy and immediate breast reconstruction. However, no significant difference was found between wound complications and no wound complications in subjects with mastectomy and immediate breast reconstruction in breast cancer recurrence (OR, 1.96; 95% CI, 0.95–4.06, P = .07), death rates (OR, 1.95; 95% CI, 0.89–4.27, P = .09), and kind of immediate breast reconstruction (OR, 1.01; 95% CI, 0.53–1.92, P = .98). The wound complications had a significantly longer length of time to adjuvant, however, no significant difference was found in breast cancer recurrence, death rates, and kind of immediate breast reconstruction. The analysis of outcomes should be done with caution even though no low sample size was found in the meta-analysis but a low number of studies was found in certain comparisons.     

Skin-sparing mastectomy and immediate breast reconstruction: a prospective cohort study for the treatment of advanced stages of breast carcinoma

Background Recent published series demonstrate the safety and effectiveness of skin-sparing mastectomy (SSM) with immediate reconstruction for the treatment of early-stage breast carcinoma. Although several reports have retrospectively evaluated outcomes after breast reconstruction for locally advanced disease (stages IIB and III), no study has specifically considered immediate breast reconstruction after SSM for locally advanced disease. Methods From 1996 to 1998, 67 consecutive patients with breast carcinoma underwent SSM with immediate reconstruction and were prospectively observed. From this group of patients, those with locally advanced disease (stage IIB, n=12; stage III, n=13) were analyzed separately. Tumor characteristics, adjuvant therapy, type of reconstruction, operative time, complications, hospital stay, and incidence of local recurrence and distant metastasis were noted. Results Breast reconstruction consisted of a transverse rectus abdominis myocutaneous flap (n=22) or a latissimus flap plus an implant (n=4). The median operative time was 5.5 hours; the average hospital stay was 5.2 days. Complications required reoperation in three patients (12%): partial skin flap necrosis in two and partial abdominal skin necrosis in one. Surgery on the opposite breast for symmetry was required in one patient (4%). Postoperative adjuvant therapy was not significantly delayed (median interval, 32 days). With a median length of follow-up of 49.2 months (range, 33–64 months), local recurrence was present in only one patient (4%), with successful local salvage treatment, and distant metastasis was present in four patients (16%). Conclusions SSM with immediate reconstruction seems safe and effective and has a low morbidity for patients with advanced stages of breast carcinoma. Local recurrence rates and the incidence of distant metastasis are not increased compared with those of patients who have had modified radical mastectomies without reconstruction.     

Wise pattern mastectomy with immediate breast reconstruction

A new technique of immediate breast reconstruction is presented. This technique uses a silicone implant placed in a subpectoral pocket, using de-epithelialised skin from the lower breast to augment the submuscular pocket, thus producing a compound myodermal flap. The technique is simple, and the resulting scar is cosmetically satisfactory; when combined with reduction mammoplasty on the opposite breast, this technique produces satisfactory breast symmetry.     

Breast paraffinoma: An obsolete but still important condition - Experience with 60 cases and the literature review

BackgroundParaffin injections for breast augmentation has been abandoned by clinicians because of its serious long-term complications. The practice is still prevalent and long-term complications are still being encountered in clinical practice today.MethodsRetrospective review was performed on patients with breast paraffinoma managed in Raja Isteri Pengiran Anak Saleha Hospital, Brunei Darussalam, between January 1, 2010 and August 31, 2020. Patients’ demographics, presentations, investigations, treatment and follow-up outcomes were reviewed. A literature review on breast paraffinoma was also performed.ResultsWe reviewed the data by combining our dataset of 60 patients with those extracted from the published articles, totaling 232 patients from 31 articles. The mean age at presentation was 48.8 (range 29–78) years with a preponderance of female patients. The most common presenting symptoms were painless lumps (65.5%), painful lumps (14.7%), ulcer (7.3%), skin discoloration (2.4%), sinus (1.7%) and abscess (1.0%). The most common imaging modality used was mammography (70.7%), MRI (52.6%) and ultrasonography (47.8%). Majority of the reported cases underwent surgical treatment; mastectomy was performed in 53.4% of the cases, excision of the paraffinoma in 17.7% of cases and 0.9% of cases had incision and drainage. A quarter of the patients (25%) did not require any further treatment. The mean follow-up was 4 (range 1–10) years with a mortality rate of 3.0%.ConclusionsAwareness of this condition will assist the clinicians in making the correct diagnosis and instituting the appropriate treatment. It is important to exclude co-existing breast cancer.     

乳腺癌术后乳房即刻再造152例报告

目的探讨乳癌根治术后即时应用单纯假体植入、可调式双囊假体植入和自体组织移植乳房再造术的适应证及疗效。方法101例在保留皮肤的乳腺癌改良根治术基础上于胸大肌下方植入Mentor假体再造乳房，39例在胸大肌下方植入Becker可调式假体再造乳房，10例用单蒂下腹部横行腹直肌肌皮瓣移植至乳房缺损区再造乳房。2例采用扩大的背阔肌肌皮瓣移植再造乳房。结果随访152例3—65个月，中位时间28个月，2例13个月后肿瘤局部复发，取出假体。术后乳房外观评价优良率达94％。结论单纯假体植入适用于乳房较小的患者，可调式假体植入乳房再造适用于乳房较大，或根治术时皮肤缺损较多的患者。     

Mastectomies avec conservation de l’étui cutané : comment éviter les souffrances cutanées ?

Skin-sparing mastectomy (SSM) has emerged as the surgical technique best adapted to the treatment of early breast cancers or breast cancer recurrences after conservative treatment; the technique is particularly appreciated by the patients who had been expecting the development of immediate, high-quality breast reconstruction for over 15 years. SSM preserves anatomical landmarks on the skin surface (notably the under-breast fold and the conical shape of the breast). The procedure must be performed by a skilled surgical team in order to maximize the quality of breast resection and reconstruction, particularly to avoid postoperative complications, notably damage to blood vessels within the skin flap and prosthesis infection. These complications generally affect the cosmetic outcome of the reconstruction, with serious short-term and long-term consequences for the acceptability of the surgical procedure, and may sometimes compromise the delivery of adjuvant treatments (either chemo- or radiotherapy). Based on our previous experience (1000 new cases since 1992), we will compare the advantages and drawbacks of the procedure, discuss its indications, describe the clinical situations encountered and the various specific interventions available, as well as the methods to reduce the risks of tissue damage and skin necrosis.     

保留乳房皮肤的乳腺切除与即刻乳房再造

目的　探讨保留乳房皮肤的乳腺切除与腹直肌肌皮瓣、背阔肌肌皮瓣加乳房假体 ,即刻再造乳房的方法。　方法　 1997年 6月～ 2 0 0 2年 6月 ,对 11例乳腺导管内原位癌和巨大乳腺良性肿瘤患者 ,经顺乳晕切口切取肿瘤活检 ,病理检查明确诊断。采用保留乳房皮肤的乳晕环形切口行乳腺或巨大肿瘤的乳腺皮下切除术 ;应用腹直肌肌皮瓣或背阔肌肌皮瓣加乳房假体即刻再造乳房 ,充填乳房的内容 ,仅以少量的肌皮瓣皮肤弥补切除后的乳头乳晕部位。再次手术时在移位后的皮瓣上再造乳头。　结果　经多科协作完成了 11例手术 ,随访 1个月始至 1～ 6年 ,效果良好 ,无肿瘤复发。其再造乳房与健侧乳房对称 ,保留了原有乳房皮肤的感觉 ,外观形态自然 ,瘢痕较少且隐蔽。　结论　在严格手术适应证防止乳腺癌复发的前提下 ,此法为一较完善的乳房再造方法。