胸大肌筋膜在乳腺癌乳房切除后即刻乳房重建中的应用

目的:探讨胸大肌筋膜在乳腺癌乳房切除后即刻乳房重建中的应用价值。方法:回顾分析2014年5月—2016年9月接受保留乳头乳晕复合体的皮下腺体切除与即刻乳房重建的18例早期乳腺癌患者临床资料。患者均采用胸大肌及其筋膜覆盖并包裹假体行乳房重建,即首先从自胸骨旁及锁骨下向外侧游离剥离胸大肌筋膜,然后在胸大小肌之间植入假体,最后用游离的胸大肌筋膜缝合胸大肌外侧缘,牢固包裹假体。结果:18例乳房重建手术均取得成功,经过12~40个月随访,所有患者未发现复发、转移,重建乳房对称性好、形态自然,未发现假体移位、挛缩,术后外观评价优良率100%。结论:对于部分早期乳腺癌患者,实施保留乳头乳晕复合体的皮下腺体切除、利用胸大肌及其筋膜覆盖假体的即刻乳房重建方法简单易行,重建乳房美容效果好,并发症少。

Application of pectoralis major fascia in immediate breast reconstruction following mastectomy for breast cancer

Objective: To investigate the value of using pectoralis major fascia in the immediate breast reconstruction following mastectomy for breast cancer. Methods: The clinical data of 18 patients with early breast cancer undergoing subcutaneous mastectomy with nipple-areola complex preservation and immediate breast reconstruction between May 2014 and September 2016 were retrospectively analyzed. All patients received breast reconstruction with prosthesis covered and wrapped by the pectoralis major muscle and its fascia, namely, firstly, the pectoralis major fascia was detached from the pectoralis major muscle, with a direction from the parasternal and infraclavicular region toward the lateral region, and then the prosthesis was implanted between the pectoralis major and minor muscles, and finally, the lateral border of the pectoralis major muscle was sutured to the detached pectoralis major fascia for firmly wrapping the prosthesis. Results: Breast reconstruction was successfully performed in all the 18 patients. During the follow-up period of 12 to 40 months, no recurrence or metastasis occurred in any of the patients, all reconstructed breasts displayed a natural shape and acceptable symmetry, no displacement or contracture of the breast prosthesis was noted, and the postoperative appearance good rate was 100%. Conclusion: For some early breast cancer patients, subcutaneous mastectomy with nipple-areola complex preservation plus immediate breast reconstruction using pectoralis major muscle and its fascia covering and wrapping the prosthesis is simple and easy to perform, with excellent cosmetic effect and few complications.