组织扩张术在即刻乳房再造中的应用

目的改进即刻乳房再造的手术方法,将软组织扩张术应用于即刻乳房再造术中,避免再造乳房术后出现"补丁样"外观,并保留乳房再造的最佳条件。方法在乳腺癌切除后即刻于胸大肌后间隙置入圆形扩张器,并于术后8~12周注水扩张至理想体积。Ⅱ期再造手术采用硅凝胶乳房假体、背阔肌肌皮瓣+硅凝胶乳房假体、背阔肌肌皮瓣及DIEP皮瓣置换扩张器完成乳房再造。结果 2009年6月至2011年6月,采用该技术进行扩张法即刻乳房再造36例,平均完成乳房再造时间3.5个月。术后无假体外露、皮瓣坏死等并发症出现,也无原手术切口的延长或新手术切口增加。术后随访6~12个月,患者对手术效果满意率达97.2%。结论采用组织扩张法进行即刻乳房再造,可以保留最佳的乳房再造条件,避免了术后放疗对乳房假体的影响,可以避免由于采用皮瓣修补胸部皮肤缺损而出现的"补丁样"外观,是理想的即刻乳房再造方法之一。

Immediate procedure breast reconstruction with tissue expansion

Objective We present our experience in immediate breast reconstruction with tissue expansion, which aimed to retain local tissue condition for breast reconstruction, overcome the limitation of radiotherapy on implant recon- struction, avoid the patch-like appearance, simplify the procedure as well as improve cosmetie result. Method The process of our method is divided into two stages. In the first stage, the round-shaped expander was implanted in the sub- pectoral major space during the procedure of mastectomy. At the same time as expander implanted, the first saline injection was performed. With 4 to 8 weeks of inflation, the tissue expander offered adequate tissue for breast reconstruction. In the second surgical stage, silicone gel implant, latissimus dorsi muscle flap deep inferior epigastrie perforator flap were used for breast reconstruction after the tissue expander was exchanged. Result 36 patients have undergone the two-staged breast reconstruction using tissue expansion from June 2009 to June 2011. The average time of total therapy was 3.5 months. There were no postoperative complications such as implant exposure, additional scar, flap necrosis. The follow-up time was 6 to 12 months and the resuh showed excellent contour of the breast at a satisfactory rate of 97. 2%. Conclusion Two- staged technique using tissue expansion in breast reconstruction was easily done with rare complications. The technique possesses advantages such as avoiding affection of radiotherapy on silicone gel implant and elasticity of skin, retaining maxi- mal local tissue for breast reconstruction. It is not necessary for correction of skin defect and additional scarring, thus the patch-like appearance of breast is avoided, so the patients are free from experiencing depression post mastectomy. Two- staged procedure of immediate breast reconstruction is a safe and reliable technique which is especially applicable to the eases that need radiotherapy.