扩大背阔肌肌皮瓣乳房再造

目的介绍单纯应用扩大背阔肌肌皮瓣进行乳房再造方法.方法将背阔肌周围脂肪组织分为5个区,在背部设计半月形皮肤切口,切取背阔肌及周围脂肪组织,不应用乳房假体,进行即时或后期乳房再造.结果应用该方法乳房再造35例,再造乳房形态良好.结论扩大背阔肌肌皮瓣乳房再造,安全有效,再造乳房形态良好,是乳房再造的重要进展.     

扩大背阔肌肌皮瓣乳房再造

目的 介绍单纯应用扩大背阔肌肌皮瓣进行乳房再造方法。方法 将背阔肌周围脂肪组织分为5个区，在背部设计半月形皮肤切口，切取背阔肌及周围脂肪组织，不应用乳房假体，进行即时或后期乳房再造。结果 应用该方法乳房再造35例，再造乳房形态良好，结论 扩大背阔肌肌皮瓣乳房再造，安全有效，再造乳房形态良好，是乳房再造的重要进展。     

扩大背阔肌肌皮瓣乳房再造

目的 介绍单纯应用扩大背阔肌肌皮瓣进行乳房再造方法.方法 将背阔肌周围脂肪组织分为5个区,切取背阔肌及周围脂肪组织,不应用乳房假体,进行即时或后期乳房再造.结果 应用该方法再造乳房95例,其中保留乳头乳晕改良根治术后即时再造24例,保留皮肤改良根治术后即时再造36例,改良根治术后即时再造26例,后期再造9例,其中1例为改良根治术后,其他8例为改良根治术后,再造乳房均形态良好.术后6例乳头部分坏死;14例胸部皮肤表皮脱落,自行愈合;2例背部供区部分坏死;背部顽固性血清肿2例,再次手术后愈合.结论 扩大背阔肌肌皮瓣乳房再造安全有效,再造乳房形态良好,尤其适用于中、小乳房的乳房再造.     

保留皮肤的乳癌改良根治术后即时背阔肌肌皮瓣乳房再造

目的介绍保留皮肤的乳癌改良根治术后即时背阔肌肌皮瓣乳房再造的经验。方法对Ⅰ,Ⅱ期乳腺癌行保留乳房皮肤经皮下切除乳腺组织,清扫腋窝淋巴结,应用背阔肌肌皮瓣即时乳房再造。结果应用该方法治疗3 7例,经随访7 5个月,再造乳房自然柔软,外观形态良好,满意率94.6%。结论保留皮肤的乳腺癌根治术后即时背阔肌肌皮瓣乳房再造具有操作方便,治疗效果良好,患者满意度高,是值得推广的好方法。     

保留皮肤的乳腺癌改良根治术后即时乳房再造

目的　介绍保留皮肤的乳腺癌改良根治术后即时乳房再造的经验。方法　对早期乳腺癌 ,保留乳房皮肤 ,切除乳腺组织和腋窝淋巴结 ,应用下腹部横行腹直肌肌皮瓣或扩大背阔肌肌皮瓣即时乳房再造。结果　应用该方法治疗 37例 ,再造乳房形态良好。结论　保留皮肤乳腺癌根治术后即时乳房再造 ,切口隐蔽 ,再造乳房形态效果好 ,对早期乳腺癌患者值得推广应用     

保留皮肤的乳腺癌改良根治术后即时乳房再造

目的介绍保留皮肤的乳腺癌改良根治术后即时乳房再造的经验.方法对早期乳腺癌,保留乳房皮肤,切除乳腺组织和腋窝淋巴结,应用下腹部横行腹直肌肌皮瓣或扩大背阔肌肌皮瓣即时乳房再造.结果应用该方法治疗37例,再造乳房形态良好.结论保留皮肤乳腺癌根治术后即时乳房再造,切口隐蔽,再造乳房形态效果好,对早期乳腺癌患者值得推广应用.     

保留皮肤的乳腺癌改良根治术后即时乳房再造

目的；介绍保留皮肤的乳腺癌改良根治术后即时乳房再造的经验。方法；对早期乳腺癌，保留乳房皮肤，切除乳腺组织和腋窝淋巴结，应用下腹部横行腹直肌肌皮瓣或扩大背阔肌肌皮瓣即时乳房再造。结果：应用该方法治疗37例，再造乳房形态良好。结论：保留皮肤乳腺癌根治术后即时乳房再造，即口隐蔽，再造乳房形态效果好，对早期乳腺癌患者值得推广应用。     

扩大背阔肌肌皮瓣在乳腺癌改良根治术后一期乳房再造中的应用

目的评价扩大背阔肌肌皮瓣在乳腺癌改良根治术后一期乳房再造中的应用价值。方法选取我科2008年1月至2009年6月期间收治的48例乳腺癌患者,根据所接受的术式分为扩大背阔肌肌皮瓣一期乳房再造（乳房再造）组（n=12）和单纯乳腺癌改良根治术（单纯根治）组（n=36）,对2组患者术后并发症、恢复情况以及生活质量进行对比,并对再造乳房外观形态进行评价。结果乳房再造组患者均成功行扩大背阔肌肌皮瓣乳房再造,再造乳房外形评价良好6例,中4例,差2例,明显优于单纯根治组（P〈0.001）。2组患者术后积液、皮瓣坏死、患肢及肩关节活动、住院时间、引流时间及开始辅助治疗时间差异均无统计学意义（P〉0.05）,但乳房再造组术后生活质量较好,与单纯根治组比较差异有统计学意义（P〈0.001）。乳房再造组有10例行术后辅助放化疗,未出现转移皮瓣坏死。2组患者随访2～17个月（中位时间8个月）,未见局部复发及转移。结论乳腺癌根治术后扩大背阔肌肌皮瓣一期再造乳房形态效果良好,手术操作简单,对早期乳腺癌是一种安全、可行的治疗方法 。     

改良背阔肌肌皮瓣乳房再造术

目的 探讨背阔肌肌皮瓣在乳房再造术中的的应用价值,为临床自体乳房再造提供一种有效的手术方式。方法 １９９４年以来,采用以背阔肌肌皮瓣及胸背动脉营养的脂肪组织联合移位,以对侧乳房的形态及体积为参照,进行取材及塑形的自体组织再造乳房。结果 ６０例（６０侧）乳房再造手术人武部成功,经过３个月～５年随访,术后效果满意４１例,占６８．３％,比较满意１６例,占２６．７％,不满意３例,占５．０％。结论 改良背阔     

保留乳头乳晕复合体的乳腺癌术后即刻乳房重建术

目的探讨乳腺癌患者行保留乳头乳晕的改良根治术后即刻扩展型背阔肌肌皮瓣乳房重建的效果。方法自2009年1月至2012年11月,对20例女性乳腺癌患者行保留乳头乳晕的乳腺癌改良根治术,术后即刻乳房重建,重建方式为应用扩展型背阔肌肌皮瓣,术后评价其再造效果。结果20例患者手术成功,恢复良好,术后5例皮下积液,局部处理后愈合;患者均获随访6~38个月,形态良好,肿瘤均无局部复发。结论乳腺癌切除术后应用同侧扩展型背阔肌肌皮瓣即刻乳房再造,可获得良好的乳房形态。     

背阔肌肌皮瓣联合假体在乳腺癌术后二期乳房再造中的应用

目的探讨背阔肌肌皮瓣联合假体植入在乳腺癌术后二期乳房再造术中的临床应用。方法 2009年至2013年,共8例乳腺癌术后年轻患者接受二期乳房再造手术。术前以排水法测定健侧乳房体积,根据患者健侧乳房形状、大小及背部组织情况,设计胸背部供区皮瓣,术中测量移植皮瓣的容积,然后根据健侧乳房和移植皮瓣的容积差,选择大小合适的乳房假体,将假体埋植于背阔肌-胸大肌后间隙,利用背阔肌肌皮瓣移植联合乳房硅胶假体进行二期乳房再造。结果本组患者术后随访6个月至4年,再造乳房外形较佳,效果满意,供区无明显并发症。结论对于年轻有生育要求的乳腺癌术后乳房缺失患者,健侧乳房较大,利用背阔肌肌皮瓣联合假体进行乳房再造,可取得良好的手术效果。     

乳癌术后的乳房再造

目的 探索乳癌根治术后3种不同乳房再造方法的最佳外观效果.方法 (1)乳癌切除Ⅱ期行扩大背阔肌肌皮瓣乳房再造.(2)乳癌切除即时腹直肌横行皮瓣乳房再造.(3)保留胸大肌乳癌切除,Ⅱ期乳房假体置入并行乳头、乳晕再造;对不保留胸大肌乳癌切除者,Ⅱ期皮肤扩张后乳房假体置入再造.结果 共计治疗12例,10例皮瓣全部成活,外观形态满意,优良率较高.2例不满意,其中1例扩张后,因局部皮肤皮下组织较薄,扩张程度不足,勉强置入140 ml乳房假体,外观形态明显偏小;另1例腹直肌肌皮瓣大部分坏死,经再次修复创面愈合,乳房再造失败.结论 乳房再造的方法选择得当,可使乳房形态更为自然.普通背阔肌皮瓣改用扩大的背阔肌皮瓣后,软组织量比前者增加1倍以上,使再造乳房与对侧相近.假体置入乳房成形后,Ⅱ期行单蒂乳头、乳晕再造,可给患者以心理和外观上的更多抚慰.     

Complications analysis of 266 immediate breast reconstructions.

The purpose of this study was to describe the complications of immediate breast reconstruction, to compare their rates with respect to the surgical procedure and to patient's characteristics, in order to improve surgical indications and patient information. We carried out a retrospective study of 266 immediate breast reconstructions (249 women) over a 12-year period (latissimus dorsi myocutaneous flap with implant 61%, autologous latissimus dorsi myocutaneous flap 15%, subpectoral implant 24%). Mean age was 48 and the median follow-up was seven years (2-14). The overall complication rate was 49% (128), and there were 10 reconstruction failures. The most frequent complications were dorsal seroma 26% (70), capsular contracture 10% (27), skin necrosis 8.3% (22), and haematoma 5.6% (15). The complication rate for immediate breast reconstruction with implant alone (39%) was lower than that associated with latissimus dorsi with or without implant (51%), but the difference was not significant (Chi-square: p=0.07). The risk factors for complications were smoking (skin necrosis, Fisher: p=0.02), obesity (infection, Fisher: p=0.004), and radiotherapy (capsular contracture, Chi-square: p=2.6 x 10(-5)). Smoking was found as the only risk factor of reconstruction failure (Fisher: p=0.015). Capsular contractures were more frequent when implants were used alone (25%) as well as when used along with a flap (6.8%) (Chi-square: p=2 x 10(-5)). Infections were also higher in the non-flap group than in the flap group (Fisher: p=0.02). In our opinion, latissimus dorsi myocutaneous flap with or without an implant is a good compromise between complication risk and necessity of good cosmetic result requirement. These results have led us to delay or contraindicate reconstruction in the case of obesity or heavy smoking. In the case of probable post-operative radiotherapy, we prefer to delay the breast reconstruction.     

乳腺癌乳房部分切除术后即刻背阔肌肌皮瓣重建乳房的临床应用

目的探讨Ⅱ期和Ⅲ期乳腺癌新辅助化疗后行乳房部分切除术,并转移同侧背阔肌肌皮瓣（latissimus dorsal myocutaneous flap,LDM皮瓣）进行即刻重建乳房的临床应用及效果。方法18例经粗针抽吸病理组织证实的Ⅱ期和Ⅲ期乳腺癌,经新辅助化疗后进行乳房部分切除术,并转移同侧LDM皮瓣进行重建乳房。术后1个月及放疗完成后1个月对重建乳房外形评分,取平均值为最后分值。采用Kaplan-Meier方法进行生存分析。结果肿瘤经新辅助化疗最大直径由30～55mm缩小至25～45mm。乳房切除标本平均重量为140g（90～220g）。重建乳房93．33％（16／18）评分3分以上。5例背部供区皮下积液（27．78％）,2例背部切口裂开（11．11％）。平均随访22个月无局部复发,1例（5．55％）远位转移（骨转移）,Kaplan-Meier生存曲线与同期根治术比较无差异。结论联合新辅助化疗的Ⅱ期和Ⅲ期乳腺癌部分乳房切除术后转移LDM皮瓣重建乳房,可提高乳房外形的满意度。     

可扩张乳房假体加背阔肌肌皮瓣的乳房再造术

目的：报告应用带蒂背阔肌肌皮瓣转移术及可扩张的乳房假体（BECKER）置入,修复乳腺癌根治术后的胸壁畸形,同时再造乳房的手术方法。方法：根据乳腺癌病灶清除术后患者胸部的畸形状况,设计患侧带蒂背阔肌肌皮瓣的肌瓣长度、体积以及皮瓣的面积和形状,切取肌皮瓣后经腋部皮下隧道转移至胸前。用肌瓣修复胸前软组织缺损,皮瓣则用于弥补胸部皮肤的不足。肌瓣与胸壁间置入可扩张的乳房假体。术后经注射壶注水,逐步扩张至额定值。6个月后,可抽除注射壶并重建乳头,完成治疗。结果：自1999年以来,对各种乳腺癌术后患者行乳房再造术共26例,获得了满意效果。结论：应用带蒂背阔肌肌皮瓣转移术及可扩张的乳房假体置入,不仅可修复乳腺癌病灶清除术后的胸部软组织的缺损、锁骨下的凹陷畸形而且可重建乳房。该法具有创伤小、恢复快、再造乳房的外形及质感逼真等特点。     

Breast Reconstruction Following Mastectomy; Patient’s Satisfaction

Breast cancer remains one of the most common malignancies in women and is one of the leading causes of cancer-related mortality. Despite the current emphasis on breast conservation, mastectomy rates remain at 30%. Mastectomy is often associated with significant psychological sequelae including distorted body image and sexual dysfunction. Breast restoration is assumed to allow a full emotional and physical recovery from a breast cancer crisis. The methods of reconstructive surgery currently practised comprise flap reconstruction, implant reconstruction and a combination of these procedures. The most commonly used flaps are transverse rectus abdominis myocutaneous (TRAM), deep inferior epigastric perforator (DIEP), latissimus dorsi (LD), gluteal artery perforator (GAP). Autogenous tissue gives the best results, and currently the best technique in most women is probably the free DIEP flap. The lower abdominal tissue can mimic the breast to a high degree.     

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。     

Post-mastectomy breast reconstruction: the soft tissue alternative

The available methods of soft tissue reconstruction of the breast are described. They are usually preferable to the use of a prosthesis. For unilateral reconstruction the appropriate method depends on the age of the patient and the size of the breast. In an elderly patient with large breast, a two-stage breast-sharing procedure is advocated. In a young patient with a small breast, an extended latissimus dorsi myocutaneous flap provides a suitable reconstruction. In a middle-aged woman with a breast of moderate size and an adequate amount of abdominal subcutaneous tissue, the most appropriate method of reconstruction is a rectus abdominis myocutaneous flap. For bilateral reconstruction where the consistency is less important, a prosthesis, with or without a latissimus dorsi flap for cover, is the method of first choice.     

Skin-Sparing Mastectomy with Immediate Breast Reconstruction by a New Modification of Extended Latissimus Dorsi Myocutaneous Flap

Background  The introduction of skin-sparing mastectomy has revolutionized both breast cancer surgery and breast reconstruction. Latissimus dorsi myocutaneous flap is a versatile flap that is gaining renewed popularity with the development of flap modifications and the continued recognition of its reliability and safety. We report our results with a new modification of the extended latissimus dorsi flap after skin-sparing mastectomy for breast cancer. Methods  From January 2002 to January 2006, 140 patients of breast carcinoma had unilateral skin-sparing mastectomy and immediate breast reconstruction. A total of 132 cases of invasive duct carcinoma and eight cases of invasive lobular carcinoma are included. Age ranged from 27 to 53 (median, 40.5) years. Tumor stage was stage I in 22 cases, stage II in 100 cases, and stage III in 18 cases. We performed a new modification to the standard extended latissimus dorsi flap, which allowed us to obtain enough autologous tissue to reconstruct the relatively large breast of the Egyptian women without implant. The postoperative aesthetic results and donor side morbidity, including contour deformity and scaring, were examined. Results  We applied both an objective and subjective aesthetic result monitoring. Aesthetic grading results of breast reconstruction were excellent in 85, good in 42, fair in ten and poor in three cases. Both flap and donor site complications were minor. Patients were followed for a median of 32.4 (range, 12-48) months. During this period of follow-up, no episode of local or distant failure was observed. Conclusions  Skin-sparing mastectomy with immediate breast reconstruction using our new modification of extended latissimus dorsi flap allows single-stage, totally autologous reconstruction with satisfactory aesthetic results and low morbidity.