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.

Repair and reconstruction of breast after mastectomy

Objective To explore the procedures of breast repair and reconstruction after mastectomy with three methods for optimal appearances of the breast.Methods Three methods were adopted in this study:(1)Two-stage breast reconstruction operation with ampliate latissimus dorsi myocutaneous flap after mastectomy;(2)One stage breast reconstruction operation with transverse rectus adbominis myocutaneous(TRAM)flap after mastectomy;and(3)Two-stage breast reconstruction and nipple repair operation with tissue expander/implant after mastectomy preserving pectoralis major museulus or implants along under pectoralis major musculus.Results All of the flaps survived well and were well-shaped in total 10 patients(10 breasts)with a flap breast reconstruetion,in which the superior ratios were 83.33%.The appearance and volume were not satisfactory in 1 patiant treated with the method of tissue expander/implant,because the volume of tissue inflation was smaller than another one and 100 ml implant was applied.The partial flap necrosis occurred in 1 case with the method of TRAM flap.Conclusions With the development of plastic surgery technique,the appearances and shapes of reconstructed breast achieve the satisfactory effects.After the ampliate latissimus dorsi myocutaneous flap is applied,the appearance and volume of reconstructed breast are similar to the healthy one.The two-stage nipple repair operation is applied with breast reconstruction operation by the tissue expander/implant after mastectomy preserving pectoralis major musculus.According to the different methods of mastectomy to choose suitable procedures of breast reconstruction,the satisfactory appearances and psychotherapy will be achieved.