乳腺切除术后即刻乳房再造术式的选择

乳腺切除术后即刻乳房再造与二期再造相比在术后效果、患者心理、住院时间以及所需费用等方面均具有明显优势.为乳腺癌术后患者选择一个合适的即刻乳房再造方式十分必要.本文对TRAM皮瓣、双蒂TRAM皮瓣、DIEP皮瓣、背阔肌肌皮瓣、扩张器/假体置入以及背阔肌肌皮瓣联合假体置入等各种即刻乳房再造术式的适应证与禁忌症进行综述.并从肿瘤学角度针对各种乳腺癌根治术如改良根治术、保留乳头、乳晕的乳腺切除术，以及保留皮肤的乳腺切除术、保乳手术后即刻乳房再造等术式的选择策略进行讨论.

Surgical Decision-making for Immediate Breast Reconstruction after Mastectomy

Compared with delayed breast reconstruction,immediate breast reconstruction(IBR) has obvious cosmetic and psychosocial advantages and it can reduce hospitalization time and cost. Choosing an appropriate method of IBR for patients who undergo mastectomy is important.Our study reviews the indications and contraindications of various methods for IBR including TRAM flap,double- pedicle TRAM flap,DIEP flap,latissimus dorsi flap,tissue expander with implants and implants cov- ered by latissimus dorsi flap.After reviewing the literature,we discuss the decision-making process in- cluding oncological aspects for IBR after modified radical mastectomy,nipple-areola complex-preserv- ing mastectomy,skin-sparing mastectomy and breast-conserving surgery.