改良三叶皮瓣法乳头乳晕再造术

女性乳腺癌发病率已占恶性肿瘤的第1位。我国越来越多的患者在乳腺癌术后接受乳房再造术。乳头乳晕再造术常用于乳房再造术后的修复，是乳房再造术的一个重要组成部分，可收到“画龙点睛”之功效。长期以来乳头乳晕再造一直是整形外科医师面临的难题之一。自Adams等报道用部分小阴唇组织移植修复乳头缺损以来，在过去的50年中，国外屡有乳头乳晕再造的新技术和新方法的报道，迄今为止国内尚未见相关文献报道。现将我们采用的一种改良三叶皮瓣(modified skate flap)乳头乳晕再造方法介绍如下。     

箭式皮瓣法乳头再造术:长时间随访及效果评价

目的 评价箭式皮瓣乳头再造的手术效果及其持久性.方法 对78例患者行回顾性研究,通过对再造乳头大小,局部皮瓣并发症发生率,切口愈合情况的长期随访来进行手术评价.结果 78例患者接受3个月以上随访,其中73例随访至6个月以上,62例随访至12个月以上,47例随访至24个月以上.再造乳头的高度和直径在术后3、6、12、24个月以上均存在不同程度地回缩.切口愈合不良者4例(5.1%),切口裂开者3例(3.8%),均经二次清创缝合后痊愈.所有患者均无局部及全部皮瓣坏死的情况发生,其中2例患者术后出现皮瓣部分淤血(2.6%),术后5d未经处理自行消退.结论 箭式皮瓣易于设计,手术操作简单,效果可靠,术后并发症发生率较低,适合于各种乳房再造患者进行乳头再造.     

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.     

双β形皮瓣及皮片移植Ⅰ期乳头乳晕再造

先天性，外伤，烧伤后乳头乳晕缺损以及乳房再造术和变性手术（男变女）后都需行乳头乳晕再造。再造后的大小、感觉、挺拔性、颜色和形态的稳定性如何，是评价手术效果的几项客观标准。我们自１９９３年６月以来应用双β形对位皮瓣结合皮片移植为男变女的易性癖患者再造乳头乳晕４例８个，收到了比较满意的初步结果。     

皮下蒂瘢痕复合皮瓣乳头再造术

目的 利用乳癌术后再造乳房局部增生瘢痕在Ⅱ期修整术时行乳头再造.方法 形成携带5.0cm×1.0cm增生瘢痕及两个翼状三角瓣的皮下蒂随意皮瓣,使蒂在乳房非整复区域内,转位移植形成乳头.采用磨削法去除表皮及真皮乳头层形成乳晕.结果 共7例患者行皮下蒂瘢痕瓣乳头再造.其中5例全部成活,形态和色泽接近自然乳头;2例瘢痕瓣远端尖部坏死,修整后成形满意.1年随访,再造乳头体积萎缩1/3～1/2,5例效果满意,2例补充局部皮瓣后效果良好.结论 利用再造乳房切口瘢痕,采用皮下蒂瘢痕复合皮瓣法再造乳头方法可行,再造乳头质地及色泽接近自然乳头.     

双β形皮瓣及皮片移植Ⅰ期乳头乳晕再造

先天性、外伤、烧伤后乳头乳晕缺损以及乳房再造术和变性手术（男变女）后都需行乳头乳晕再造。再造后的大小、感觉、挺拔性、颜色和形态的稳定性如何，是评价手术效果的几项客观标准。我们自１９９３年６月以来应用双β形对位皮瓣结合皮片移植为男变女的易性癖患者再造乳头乳晕４例８个，收到了比较满意的初步结果。     

双β形皮瓣及皮片移植Ⅰ期乳头乳晕再造

先天性、外伤、烧伤后乳头乳晕缺损以及乳房再造术和变性手术(男变女)后都需行乳头乳晕再造。再造后的大小、感觉、挺拔性、颜色和形态的稳定性如何,是评价手术效果的几项客观标准。我们自1993年6月以来应用双β形对位皮瓣结合皮片移植为男变女的易性癖患者再造乳头乳晕4例8个,收到了比较满意的初步结果。     

改良"箭头"皮瓣法乳头乳晕再造术

目的 介绍改良"箭头"皮瓣法乳头乳晕再造术的应用经验.方法 将"箭头"皮瓣法乳头乳晕再造术的设计经过凋整改进,为曾使用自体组织行乳房再造的患者再造乳头乳晕12例,其中2例采用改良"箭头"皮瓣法+薄中厚皮片移植乳头乳晕再造,4例采用改良"箭头"皮瓣法+自体肋软骨埋置+乳晕文身的乳头乳晕再造,6例采用"箭头"皮瓣法+乳晕文身的乳头乳晕再造.结果 再造乳头全部成活,其中2例术后1个月时再造乳头回缩完全变平,其余10例术后3个月时再造乳头回缩率约50%,跟踪随访6个月至1年,再造乳头大小稳定,与对侧基本对称.结论 本手术方法设计合理、操作简单,且无需另选供区,远期乳头突度维持也良好.     

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.     

乳癌手术一期乳房再造及乳头乳晕再造术

乳癌手术一期乳房再造及乳头乳晕再造术北京市肿瘤防治研究所外科（１１００３４）薛钟麒山东省即墨市人民医院外科毛天训北京西城区展览路医院外科祁雷，井同庆北京建材院职工医院苏敏近１０年来，国内对乳癌手术后，施行胸壁外形肌皮瓣的修复，提高患者生活质量，已日受...     

The "Swiss-Roll" flap: a modified C-V flap for nipple reconstruction

Nipple reconstruction is an integral step in breast reconstruction. There are a variety of local-flap based techniques however one of the most commonly used is the C-V flap. The traditional flap forms a nipple shell composed of dermis and epidermis containing a core of subcutaneous fat. The shortcomings of this technique are that it relies on subcutaneous fat for nipple bulk and with time loses a significant part of its volume. We present a modification of the C-V flap designed for use in breasts with little subcutaneous fat in order to minimise post-operative nipple projection loss.     

The angel flap for nipple reconstruction

Creation of an aesthetically pleasing nipple plays a significant role in breast reconstruction as a determining factor in patient satisfaction. The goals for nipple reconstruction include minimal donor site morbidity and appropriate, long-lasting projection. Currently, the most popular techniques used are associated with a significant loss of projection postoperatively. Accordingly, the authors introduce the angel flap, which is designed to achieve nipple projection with lasting results. The lateral edges of the flap and the area surrounding the top of the nipple are de-epithelialized and the flaps are wrapped to create a nipple mound composed primarily of dermis. Decreasing the amount of fat within core of the nipple and enhancing dermal content promotes long-lasting projection. Furthermore, the incision pattern fits within a desired areolar size, preventing unnecessary superfluous extension of the incisions. Thus, the technique described herein achieves the goals of nipple reconstruction, including adequate and long-lasting projection, without extension of the lateral limb scars.     

Patient-reported outcomes for nipple reconstruction: Review of literature

BackgroundThere is currently no validated patient-reported outcome measure (PROM) that is specific to nipple–areola complex (NAC) reconstruction. This paper evaluates all patient-reported outcomes for NAC reconstruction in the literature.MethodsSystematic literature searches of The Cochrane Central Register of Controlled Trials, MEDLINE and World Health Organization International Clinical Trials Registry Platform were conducted to identify all primary studies with patient-reported outcomes for NAC reconstruction. The primary outcome measures were patient satisfaction rates for appearance and symmetry of NAC reconstruction.ResultsFifty-nine papers were included in this review. Reported patient satisfaction was generally high, with the pooled average satisfaction rate for appearance being 81.9% and symmetry 80.3%. 89.5% of respondents would do it again and 94.8% would recommend it to others. There is no standardised or validated PROM specific to NAC reconstruction and this contributes to a lack of conclusive findings from studies in this area.ConclusionThere is a need for a validated PROM that is specific to NAC reconstruction, in order to serve as a standardised outcome assessment to guide further research and improve patient care.     

A new method for using a silicone rod for permanent nipple projection after breast reconstruction procedures

Nipple-areola complex (NAC) is a unique part of the human body. Not only is it a functional structure, but it plays an aesthetic role as well. It offers the final touch to the convex shape of the breast. Its lack frequently leads to depression in patients. This paper describes the method used by the authors for reconstructing nipple mound projection in patients following an autologous breast reconstruction procedure.To reconstruct the nipple mound an adapted local C-V flap technique described by Losken was used, with a silicone rod to support the nipple. The new method is based on simple preparation of flaps, fixing the silicone rod at the nipple bottom and below the top, it is quick and efficient in terms of time and materials used.The procedure was conducted in 30 patients: 10 cases following LDf reconstruction and Becker prosthesis or expander prosthesis, 20 cases following body tissue reconstruction with TRAM flap (Transverse Rectus Abdominis Musculocutaneous flap). All the patients who had undergone the LDf procedure developed flap necrosis followed by rod removal. In the patients who had undergone TRAM flap reconstruction no necrosis or wound split was observed, healing progressed without complications. In this group durable nipple projection was achieved. The new method for reconstructing nipple projection may be applied both in simultaneous and staged procedures, only in patients who have undergone autologous breast reconstruction procedure.     

Nipple reconstruction using a modified arrow flap technique

Nipple reconstruction is the perfection of breast reconstruction. Although many reconstruction techniques are available, all come with the risk of projection loss. Most of the commonly used local flap techniques give reliable immediate results, but are associated with a loss in projection of 50 to almost 70% over the first three postoperative years. We herein present a modification of the nipple reconstruction technique as presented by Thomas et al. in 1996. By forming a deepithelialized area when closing the skin donor site, a firm foundation plate for the new nipple is created. The authors observed that this solid foundation plate, as well as the separation of the nipple cavity of the subcutaneous fat, results in less nipple projection loss.     

Nipple reconstruction with muscle flap

The author presents a case of nipple reconstruction using rectus abdominal pedicle flaps to maintain nipple protrusion.     

Expanding the transplanted areola in breast reconstruction

Summary A simple single stage method of nipple and areola reconstruction has been used in a number of cases following unilateral breast amputations, removal of nipple and areola for benign tumor and post surgical accidental loss. The combination of areolar sharing and meshing of the graft inables the surgeon to cover the size of a normal areola. The taking of the graft does not alter the shape and the function of the normal side since it is not totally detached from its donor site.     

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。     

Retention of a reconstructed nipple using a C-V flap with different layer thicknesses in the C-flap

Background: The C-V flap for nipple reconstruction is now one of standard surgical techniques. But decreased projection is still a problem. In recent years, it has been suggested that projection can be more easily maintained when raising of the C-flap is performed with a split thickness dermis. In this study, we examined whether decrease of projection can be prevented by raising of a C-flap with a split dermis rather than with full dermis.

Methods: A total of 49 consecutive patients who underwent reconstruction of a nipple using the C-V flap technique were enrolled. The patients included 22 who underwent surgery using a C-flap with a full thickness dermis (Group F), and 27 who underwent surgery with raising of a flap with a split thickness dermis (Group S). The size of the reconstructed nipple was measured at 2?weeks, 6?months and 1?year postoperatively for comparison between Groups F and S.

Results: Partial necrosis of the C-flap end occurred in 4 subjects in only Group S. The decrease in projection after 1?year postoperatively in Group S was significantly lower than that in Group F. In contrast, the teat base size in Group F tended to be greater than that in Group S, suggesting a tendency for an expanded base using a flap with a full dermis.

Conclusions: Our results indicated that it is recommended to use a C-flap with a split dermis for cases with high projection of the nipple on the contralateral side.