PR15THE BRANCHING PATTERN OF THE DIEA FOR PERFORATOR FLAPS: THE IMPORTANCE OF PREOPERATIVE CT ANGIOGRAPHY

Introduction Implant‐based breast reconstruction has evolved from two‐stage methods using round smooth expanders to single‐stage using definitive textured biodimensional anatomical expander‐prostheses. The aim of this study was to assess if single‐stage reconstruction is achievable using McGhan 150 expander‐implants with latissimus dorsi (LD) myocutaneous flaps and if so, at what cost. Methods Data was collected retrospectively on all women who underwent this type of breast reconstruction, between 1997–2005, with a minimum of 6 months follow‐up. Results 147 patients had 164 reconstructions (17 bilateral cases). Mean age 48 ± 9 years. The indications for reconstruction were mastectomy, breast asymmetry and Poland’s syndrome. 144 patients had pedicled flaps and 3 patients had contralateral free flaps. The majority were delayed reconstructions. Single‐stage reconstruction was achieved in 81/147 patients. The number of procedures per completed reconstruction was 2.2 or 1.9 if nipple‐areola reconstruction and contralateral surgery were excluded. The overall complication rate was 38%. Implants were removal for infection in 12% and exchanged for capsular contracture in 15%. LD/expander‐implant reconstruction failed in 3 patients. Conclusions Single‐stage reconstruction is an achievable goal but patients should be counselled that further surgery might be required to complete the reconstruction.     

Prospective evaluation of immediate reconstruction after mastectomy.

OBJECTIVE: The authors prospectively studied the impact of immediate breast reconstruction on patients undergoing mastectomy. SUMMARY BACKGROUND DATA: Despite the advocation of a breast-conserving approach to the treatment of breast cancer, many women continue to medically require or choose mastectomy for the treatment of breast cancer. In recent years, immediate breast reconstruction has become an alternative to either mastectomy alone or to delayed reconstruction. METHODS: A prospective database of 216 patients who underwent mastectomy with immediate reconstruction was established. In this series, 94 procedures involved implants or tissue expanders, and 124 tissue transfers were performed. RESULTS: The overall complication rate was 15.3%; only 9% of patients who underwent autologous tissue transfers required secondary procedures. When implants were performed, the overall rate of prosthetic loss was 8%. The majority of patients (n = 101) underwent transverse rectus abdominis musculocutaneous (TRAM) flaps. Twenty-six of the 38 (17.5%) patients who required transfusion were from this group. Partial flap losses in this group (7%) were correlated to a history of heavy smoking. With a median follow-up of 33.2 months, only two patients had recurred locally. According to patient opinion, autologous tissue transfers resulted in a statistically better cosmetic result. CONCLUSIONS: Immediate reconstruction can be performed safely and with excellent cosmetic results.     

Determinants of aesthetic satisfaction following TRAM and implant breast reconstruction

INTRODUCTION: Several studies have evaluated patient satisfaction following breast reconstruction with the transverse rectus abdominis myocutaneous (TRAM) flap and tissue expander/implant. However, the specific aesthetic determinants of patient satisfaction have not been determined. METHODS: Patients who had undergone tissue expander/implant or TRAM flap reconstruction were retrospectively polled on their age, type and timing of reconstruction, mastectomy type, laterality of reconstruction, adjuvant therapy, and symmetrizing and nipple-areolar procedures. Aesthetic satisfaction based on breast shape, symmetry of breast shape, breast size, symmetry of breast size, breast scarring, and breast sensation was assessed using a 5-point scale. RESULTS: Two hundred eleven patients with 105 TRAM flaps and 160 expander/implants responded. Unilateral TRAM recipients rated their breast shape, symmetry of breast shape, and symmetry of breast volume significantly higher than did implant patients. When bilateral reconstruction patients were evaluated, no significant differences were seen. The presence of nipple-areolar reconstruction positively influenced every parameter except breast sensation. Immediate reconstruction, skin-sparing mastectomy, and age >60 years at the time of reconstruction were also associated with higher scores, while postoperative radiation therapy resulted in lower satisfaction. Free flap reconstruction produced higher satisfaction in breast shape and breast scarring when compared with pedicle flap reconstruction. CONCLUSIONS: Aesthetic satisfaction after breast reconstruction is highly influenced by the presence of nipple-areolar reconstruction and less so by age, timing of reconstruction, adjuvant therapy, or free flap procedures. The type of reconstructive procedure is a significant variable only in unilateral reconstruction.     

Risk factors for complications of radiation therapy on tissue expander breast reconstructions

Radiation therapy has been shown to increase complication rates of tissue expander/implant breast reconstructions. The purpose of this study was to evaluate patient characteristics to assess their impact on complications. A retrospective review of patients who underwent mastectomy plus tissue expander/implant reconstruction from January 2000 to December 2006 was performed. The main outcome of interest was the development of postoperative complications. Analyses were performed to detect risk factors for complications. A total of 560 patients were included in the study. A total of 385 patients underwent unilateral and 174 underwent bilateral tissue expander/implant reconstructions, for a total of 733 reconstructions. A total complication rate of 31.8% and a major complication rate of 24.4% were calculated. The risk factors associated with a significantly increased incidence of complications were age greater than 50 years, body mass index (BMI) greater than 30, and radiation. Women younger than 50 years had a complication rate of 28.4%, whereas women older than 50 years had a complication rate of 37.0%. Women with a BMI less than 30 had a complication rate of 27.5%, whereas women with a BMI greater than 30 had a complication rate of 49%. The major complication rate in nonradiated and radiated patients was 21.2% and 45.4%, respectively. Despite higher complication rates, tissue expander/implant reconstructions were successful in 70.1% of radiated patients. Based on this study, the ideal radiated patient would have a BMI less than 30 and be younger than 50 years of age to maximize the likelihood of a successful tissue expander/implant reconstruction.     

Breast reconstruction: a possible balance between oncological therapy, reconstructive methods and the patients]

BACKGROUND: Based on their experience of oncological surgery and wishing to respond to the patients' reconstructive requirements, the authors analyse the damage caused by medical therapy (chemo-hormone therapy and radiotherapy) in terms of reconstructive techniques; they aim to establish whether the tissues used in reconstruction interfere with the diagnosis and treatment of recidivations and to identify the best reconstructive strategy in relation to "timing"; lastly, they examine the possibility of realising a cosmetically improved breast. METHODS: A 2-year retrospective study was made during which 3 patients underwent immediate reconstruction using expanders (including 2 with bilateral reconstruction) and 1 patient underwent postradiotherapy differed reconstruction; all patients were followed up for a maximum of 4 years. The following surgical methods were used to improve cosmetic results: 1) conservation of the pectoralis minor which was turned sideways to create the muscular pocket; 2) costal and sternal disinsertion of the pectoralis major; 3) the implant was covered with the muscular pocket in the upper quadrants and with subcutaneous tissue in the lower quadrants; 4) realisation of a mammary groove; 5) immediate mastopexy of the surviving breast. All patients underwent intraoperative and postoperative polychemotherapy. RESULTS: At present (January 1997) none of the patients treated shows signs of locoregional recidivation or general metastases. Complications were observed in the form of subacute infection of the prosthetic flap exposing the expander and infection of the suture material used to reshape the breast in contralateral mastopexy in the patient undergoing reconstruction after radiotherapy. When evaluating the cosmetic results, scar diastasis varied in all patients. Smoothing of the scars, slight implant distortion observed echographically, grade 2 contraction of the periprosthetic capsule were assessed using Baker's scale and all patients were found to be grade I or II. In the light of these results and their personal experience, the authors then analyse, with reference to the literature, the effect of radiotherapy on reconstruction using tissular expansion, the effect of chemotherapy on reconstruction using expansion or autologous implants; the combined effect of radio and chemotherapy on reconstruction using autologous implants or tissues. Timing and the difficulty of diagnosis locoregional recidivation are also discussed. CONCLUSIONS: The authors fully agree with the need to carry out immediate reconstruction, when indicated (above all in bilateral reconstruction) using implants since it is simpler. Chemotherapy does not interfere with the expansion process whereas, if it is deemed necessary to use radiotherapy, it is certainly better to undertake reconstruction using autologous tissues. For special reconstruction methods (replacement of the expander, differed reconstruction with expander), greater use should be made of the day hospital, or better still office surgery.     

Staged sentinel lymph node biopsy before mastectomy facilitates surgical planning for breast cancer patients

BACKGROUND: In patients with breast cancer who choose mastectomy with immediate reconstruction, the sentinel lymph node (SLN) status on permanent histology may complicate treatment if a metastasis is found. The purpose of this study was to determine how performing an SLN biopsy (SLNB) before the definitive operation would influence subsequent surgical procedures. METHODS: Our SLN database was searched for patients who underwent staged SLNB with subsequent mastectomy between 2001 and 2004. RESULTS: Twenty-five patients with 27 breast cancers underwent SLNB before mastectomy. Of them, 9 of 27 (33%) were node positive. All 9 patients underwent modified radical mastectomy. Three node-positive patients did not undergo immediate reconstruction. Of the remaining 6 node-positive patients, 5 underwent reconstruction with autologous tissue rather than a tissue expander. In contrast, 6 of 16 (37%) node-negative patients underwent reconstruction with a tissue expander. CONCLUSIONS: Staged SLNB assists in selecting the appropriate operation in patients who are considering immediate reconstruction.     

The effect of timing of postmastectomy radiation on implant-based breast reconstruction: a retrospective comparison of complication outcomes

Background

The optimal timing of postmastectomy radiation for women undergoing delayed permanent implant exchange continues to remain controversial. The objective of our study is to compare complication rates when tissue expanders are exchanged for permanent implants pre- vs postradiation.

Methods

A retrospective review of 54 consecutive patients who underwent implant-based breast reconstruction and received postmastectomy radiation was conducted. Complications including infection, implant loss, and capsular contracture (measured in Baker score) were compared between the 2 groups.

Results

Of the patients studied, 32 patients had radiation before placement of permanent implants, whereas 22 patients received radiation after implant placement. There was no difference in individual complication rates between the 2 groups.

Conclusions

In our study of 54 patients, the timing of radiation did not affect individual complication rates for patients who underwent implant-based breast reconstruction after immediate tissue expander placement.     

Multicenter Study on Breast Reconstruction Outcome Using Becker Implants

The use of tissue expanders and implants is the simplest option for breast reconstruction following mastectomy. In the 1980s, Hilton Becker introduced a round, inflatable breast implant that could be used as a permanent implant. Since then, the original implant has been improved in both design and architecture. The new Becker device consists of an anatomical implant composed of 35% cohesive silicone gel in the outer chamber and 65% normal saline in the inner chamber. This multicenter study describes our experience with the new anatomical Becker implants in a large series of patients, in both immediate and delayed breast reconstruction. We reviewed the clinical records of 204 patients who underwent a breast reconstruction with an anatomical Becker-type implant in the sub-muscular position between November 2004 and December 2006. Data on the patients’ characteristics, indications for reconstruction, operative technique, device size used, complications, and need for further operations were collected and analyzed. A total of 248 breast reconstructions were performed in 204 patients. One hundred forty-three patients (70%) underwent an immediate reconstruction; in the remaining 61 cases (30%), the breast reconstruction was performed later. The patients’ age ranged from 26 to 66 years, with a median age of 47.5 years. The implant was placed unilaterally in 160 women (78.5%) and bilaterally in the remaining 44 (21.5%). Complications occurred in 85 cases (34.2%), in both the immediate and delayed reconstruction groups, and were related to wound healing, bleeding, seroma, and problems with the inflatable expanders. Iatrogenic implant rupture was documented in one case (0.4%). Inflation was impossible in 7 cases (2.8%) as a result of valve obstruction (3 cases, 1.2%) and valve displacement (4 cases, 1.6%). Implant malposition was the most troublesome complication; indeed, 34 patients (13.7%) complained of device malposition. Capsular contracture was assessed in all the patients. Significant capsular contracture (Baker grade III and IV) was detected in 6 cases (2.4%) at the follow-up approximately 1 year after surgery. Breast reconstruction with permanent inflatable expanders is widely acknowledged as a useful technique for breast cancer patients undergoing simple or modified radical mastectomy. The use of this device eliminates the need to replace a temporary tissue expander with a breast implant, thus avoiding a second operation. Although we believe autologous tissues afford the best method of reconstruction in the majority of patients, the results of our study show that expander implant placement may yield a reasonable reconstruction.     

Technical aspects of immediate breast reconstruction with implants: five year follow-up.

We describe the technical aspects of 249 patients who had immediate breast reconstruction with implants and a follow-up of at least five years. The type of reconstruction was permanent expander prostheses (n=208), permanent prostheses (n=32), and temporary expander prostheses (n=9). The median total number of operations required to complete the reconstruction was 3 (range 1-6) with nipple-reconstruction included. Thirty-two patients developed local complications (13%) and three had systemic complications (1%). Eighteen implants were lost, so the failure rate of reconstruction was 7%. The technique of immediate breast reconstruction with implants is associated with a low overall morbidity. This, combined with earlier reported psychological advantages, no increased risk of cancer relapse, and reasonable cost, indicates the importance of immediate reconstruction with implants in the treatment of breast cancer.     

Delayed two-stage breast reconstruction with implants: The authors�� recent experience

BACKGROUND:

Presently, breast cancer detection is delayed in Poland and, thus, the only other option for patients is amputation and breast reconstruction (immediate or delayed). Reconstructive methods are based on using the patient’s own tissue (pedicled or free myocutaneous flaps) or implants (a tissue expander, which is later exchanged for a prosthesis or an expandable implant).

OBJECTIVE:

To evaluate the aesthetic results of a delayed two-stage breast reconstruction with the use of implants (expander and prosthesis) in patients who have previously undergone cancer-related mastectomy.

METHODS:

From 2006 to 2009, 54 patients (34 to 65 years of age) underwent reconstruction at least one year after their mastectomy and adjuvant chemotherapy; three women also received x-ray therapy. All women underwent a two-stage treatment with a tissue expander, which was later exchanged for a prosthesis.

RESULTS:

Outcomes of the surgery (evaluated by the physician and the patient at least six months after all stages of reconstruction) were found to be very good in 42 patients and good in 12 patients. After amputation and x-ray therapy in two cases, a fistula developed, which necessitated implant removal.

CONCLUSIONS:

After amputation, breast reconstruction with implants (expander and prosthesis) provides good aesthetic results. The method is mildly burdening to the patient and does not cause severe scarring. Symmetrization of the second breast is often recommended; however, the cost is not covered by the national health system. In principle, earlier x-ray therapy disqualifies the application of implants. Dividing reconstruction into two stages (expander and prosthesis) allows for possible correction of prosthesis placement.     

Infusion port dislodgement of bilateral breast tissue expanders after MRI

Tissue expanders are placed routinely for breast reconstruction, and magnetic resonance imaging (MRI) is a common diagnostic procedure. Many studies have reported on the safety of MRI in patients with nonferromagnetic implants; however, many tissue expanders contain ferromagnetic components. The authors present a case of bilateral tissue expander infusion port dislodgment after MRI. A 56-year-old woman underwent bilateral mastectomy and immediate reconstruction with McGhan BIOSPAN tissue expanders. These implants contain integral nonferromagnetic infusion ports, as well as small, powerful Magna-Site magnets. Several weeks postoperatively the patient underwent MRI of her spine, which was ordered by her primary physician for back pain. Subsequently, the infusion ports could not be located with the finder magnet. A chest radiograph was obtained, which demonstrated bilateral dislodgment of the infusion ports. Surgical removal and replacement of the tissue expanders were required. Safety considerations of MRI have been discussed extensively in the literature, and data on MRI with various implanted devices have been obtained. The potential risks of performing MRI on patients with metallic implants include conduction of electrical currents, heating of the implant, misinterpretation resulting from artifact, and the possibility of movement or dislodgment of the implant. The small magnet integral to many tissue expanders may be overlooked by patients and physicians during pre-MRI screening. All patients undergoing tissue expansion with implants that contain integral ports should be thoroughly warned about the potential hazards of MRI.     

Mastectomy with breast reconstruction in previously augmented patients: indications for implant removal

Surgeons performing breast reconstruction in previously augmented patients can either leave the preexisting implant in place and incorporate the implant into the reconstruction, or remove the implant, usually performing an implant exchange. The focus of this study is to identify indications for implant removal in previously augmented patients undergoing mastectomy with breast reconstruction. We performed a retrospective chart review of patients who underwent breast reconstruction from 1997-2007 at University of Alabama, Birmingham Medical Center. Of these patients, 54 had previous augmentation with silicone or saline implants. Twenty-two of these underwent bilateral breast reconstruction, making a total of 76 reconstructed breasts. Patients were followed for a mean of 2.1 years (range 0.1-5.1 years). The mean body mass index was 23.0 (range 18-30). Implants were explanted in all but one patient. Reasons for implant removal or exchange included subglandular position (n = 39), aged silicone implant (n = 50), rupture or leak (n = 24), implant exposure (n = 1), and infection (n = 1). Some patients had more than one reason for explantation. We recommend removal of preexisting implants for patients who have implants in a subglandular position, ruptures or leaks, site infections, implant exposures, capsular contractures, pain, indolent seromas, aged silicone implants, poor cosmesis, plans for or history of radiotherapy, and close proximity of tumor to implant. We also remove implants to respect patient preferences and to achieve symmetry in our reconstruction. Consequently, we find in our practice that most of previously augmented patients who undergo breast reconstruction will also undergo implant removal.     

Acellular Dermis-Assisted Breast Reconstruction

BACKGROUND: In 2004, the authors reported their findings with placement of tissue expanders for breast reconstruction in the partial submuscular position, the equivalent of the "dual-plane" technique for breast augmentation. Limitations with subpectoral expander placement include difficulty controlling the lower pole of the pocket during expansion, unprotected device coverage by a thin inferior mastectomy flap, possible effacement of the inframammary fold, and limited control over the superior migration of the pectoralis major muscle. This study aimed to examine the safety and efficacy of an acellular dermal sling in providing inferolateral support to the device during immediate breast reconstruction and expansion. METHODS: This study prospectively investigated 58 breasts of 43 consecutive women who underwent immediate breast reconstruction with tissue expanders and acellular dermis. After completion of adjuvant therapy and expansion, the devices were exchanged for implants. The patients were tracked through January, 2007. The study parameters included demographic information, oncologic data, complications, and aesthetic outcomes. RESULTS: The mean time required to complete reconstruction was 8.6 months. The overall complication rate after expander/acellular dermis placement was 12%, whereas the complication rate after exchange to implants was 2.2%. The aesthetic outcome for reconstructed breasts did not differ significantly from that for the control subjects who had no surgery. CONCLUSIONS: Acellular dermis appears to be a useful adjunct in immediate prosthetic breast reconstruction. Acellular dermis-assisted breast reconstruction has a low complication rate, helps to reconstruct an aesthetically pleasing breast, and facilitates expeditious completion of the reconstruction.     

Technical aspects of immediate breast reconstruction with implants: Five year follow-up

We describe the technical aspects of 249 patients who had immediate breast reconstruction with implants and a follow-up of at least five years. The type of reconstruction was permanent expander prostheses (n=208), permanent prostheses (n=32), and temporary expander prostheses (n=9). The median total number of operations required to complete the reconstruction was 3 (range 1–6) with nipple-reconstruction included. Thirty-two patients developed local complications (13%) and three had systemic complications (1%). Eighteen implants were lost, so the failure rate of reconstruction was 7%. The technique of immediate breast reconstruction with implants is associated with a low overall morbidity. This, combined with earlier reported psychological advantages, no increased risk of cancer relapse, and reasonable cost, indicates the importance of immediate reconstruction with implants in the treatment of breast cancer.     

Immediate single-stage breast reconstruction using implants and human acellular dermal tissue matrix with adjustment of the lower pole of the breast to reduce unwanted lift

Breast reconstruction using implants remains an aesthetic challenge toward achieving symmetry and natural appearance. Closing the areolar defect results in a vertically elevated breast mound. The use of human acellular dermal tissue matrix has been reported to provide coverage and durability over breast implants while allowing for improved shape of the reconstructed breast. This study reports the operative technique used in a series of breast reconstructions using saline implants and human acellular dermal tissue matrix in an immediate one-stage procedure. Complications and appearance were evaluated for all reconstructions. Indications for inframammary fold reconstruction and lower pole breast enhancement using chest skin advancement were discussed. Twenty-three patients were included in the study; 11 had unilateral reconstruction and 12 had bilateral reconstruction for 35 total reconstructions. All patients had immediate reconstruction following skin-sparing mastectomy. Nine patients had inframammary fold reconstruction and 11 patients had a lower chest advancement flap with fold reconstruction. The mean follow-up was 9.5 months with a range of 1 to 24 months. Complications occurred in 3 patients. Human acellular dermal tissue matrix can successfully be used in conjunction with breast implants to achieve an aesthetically pleasing breast reconstruction in one stage at the time of skin-sparing mastectomy. The use of a tissue expander and its associated risks and costs are eliminated. The complication rate is low. In addition, either inframammary fold reconstruction or lower chest advancement and fold reconstruction to augment lower pole skin coverage can improve symmetry with the opposite breast.     

乳癌术后不同乳房再造术式的临床应用

目的探讨适合乳癌术后各种乳房再造术式的适应证。方法对我院2003至2005年收治的44例、45只乳癌术后乳房再造的患者,根据不同情况分别采用扩张器/假体置入(5只)、背阔肌肌皮瓣 假体置入(13只)、背阔肌肌皮瓣(3只)、DIEP皮瓣(6只)、单蒂TRAM瓣(10只)及劈开的双蒂TRAM瓣(8只)等方法进行乳房再造,分析各手术方法的适应证。结果应用皮瓣乳房再造40只,皮瓣全部成活;1只应用扩张器/假体乳房再造术后,注射壶部表皮坏死;1只应用背阔肌 假体乳房再造术后半年出现假体破裂伴局部感染;1只应用DIEP乳房再造术后,出现皮瓣下积液;2只部分皮瓣坏死。术后随访3个月至半年,医生及患者对乳房形态均较满意。所有应用腹部皮瓣的患者均无腹壁疝发生。结论6种乳房再造技术基本满足了我国女性乳癌术后各个时期各种条件再造乳房的要求,整形外科技术的改进以及新材料的应用扩大了乳房再造的适应证。     

Bilateral immediate two-stage breast reconstruction in patients with unilateral breast cancer: Outcomes analysis and risk assessment

IntroductionContralateral prophylactic mastectomy has the potential to decrease the occurrence of cancer and reduce psychological burden. However, it is known that complications after bilateral mastectomy are higher compared with unilateral mastectomy. Our goal was to evaluate outcomes of immediate breast reconstruction in patients undergoing bilateral mastectomy and to compare complication rates between therapeutic and prophylactic sides.Patients and MethodsElectronic medical records of patients with unilateral breast cancer who underwent bilateral mastectomy and immediate reconstruction with expanders were reviewed. Postoperative complications were compared between therapeutic and prophylactic mastectomy sides.ResultsSixty-two patients were analyzed. The overall complication rate after both stages was 23.9% on the therapeutic side and 16.5% on the prophylactic side. Infection was the most common complication on both sides. All infections on the prophylactic mastectomy side were successfully treated with intravenous (IV) antibiotics (salvage rate of 100%), whereas 35.7% of infected tissue expander/implants on the therapeutic mastectomy side were explanted despite treatment.ConclusionCareful counselling of patients undergoing elective contralateral prophylactic mastectomy is essential as complications can develop in either breast after reconstruction.     

Immediate breast reconstruction: A retrospective study with emphasis on complications and risk factors

Abstract

The use of skin-sparing mastectomy (SSM) with immediate reconstruction is preferred, as it has cosmetic and psychological advantages, and comprises one operation. We retrospectively reviewed the complication rate after SSM and immediate reconstruction with implants in 141 consecutive patients with 208 reconstructions. Risk factors were related to both patients and the procedure. The overall morbidity was 42/208 (20%) with one or more minor or major complications including epidermolysis, skin necrosis, or infection. The overall explantation rate was 26/208 (13%). Smoking was a significant risk factor for infection and explantation, and tended to increase risk of necrosis (p = 0.05). Preoperative radiation did not increase the risk of explantation. Age above the median of 44 (range 25–67) years implied a significantly increased risk of epidermolysis, infection, and explantation. Women who had a one-stage procedure with implantation of fixed-sized implant experienced explantation four times more often than women who had a two-stage procedure with tissue expander (p = 0.001). In conclusion, SSM with immediate reconstruction yields a low complication rate when patients are carefully selected. SSM with immediate reconstruction should be done for younger women who have had no previous radiation. Patients should stop smoking to ensure optimal outcome.     

可扩张乳房假体在一期乳房再造术中的应用

目的探讨乳癌根治术后应用可扩张乳房假体置入一期乳房再造术的适应证、手术方法、手术效果。方法2002年1月至2006年3月，30例患者采用乳癌根治术后可扩张乳房假体置入一期乳房再造术，其中5例保留了乳头乳晕。结果手术效果较为满意，3例乳房出现微小并发症，其中2例皮瓣局灶坏死，另1例出现乳头乳晕部分坏死。结论可扩张乳房假体置入乳房再造术适用于不适合单纯乳房假体置入法乳房再造术者，其与先行扩张器置入进行皮肤软组织扩张，然后置换乳房假体的乳房再造方法相比，减少了1次大手术，术后恢复快，不增加额外瘢痕。     

Successful prosthetic breast reconstruction after radiation therapy

Radiation has been considered a relative contraindication to prosthetic breast reconstruction. While this dogma has been challenged by recent reports, the data on radiation and immediate prosthetic reconstruction remain contradictory. We performed a controlled retrospective review of one surgeon's 7-year experience with 21 irradiated patients who underwent tissue expander/implant breast reconstruction. When compared with nonirradiated patients, irradiated patients experienced a higher rate of seroma formation, infection, delayed healing, implant exposure, and systemic complications. The rate of capsular contracture, while significantly higher in the irradiated group, was comprised mostly of mild to moderate capsules. Hematoma formation, implant rupture, and operative revision rates were similar between the 2 groups and complication rates among irradiated patients remained overall low. This study supports prosthetic reconstruction as a reasonable option for many radiation patients. Although irradiated patients remain at higher risk for complications, overall complication rates are low and rates of successful reconstruction are high.