24例保留乳头乳晕乳腺癌术后即刻乳房重建的临床经验

目的:探讨保留乳头、乳晕及部分乳房皮肤的乳腺癌改良根治术后即刻采用不同的方法乳房重建的可行性。方法:筛选出病理符合要求的24例早期乳腺癌患者，行保留乳头、乳晕及部分皮肤的改良根治术，根据患者的要求，结合其身体、心理、经济等状况，特别是乳房的大小和需要切除的尺寸，选择适合该患者的手术方式即刻行乳房重建，采用硅胶充填假体置入乳房重建9 例，腹直肌肌皮瓣乳房重建3 例，背阔肌肌皮瓣和硅胶填充假体联合重建12例。术后根据客观标准和主观标准评价重建效果。结果:24例乳腺癌患者术后即刻乳房再造术后外观良好，双侧乳房基本对称。客观评价效果优良和尚好者23例（95.83%），主观评价优良和尚好者24例（100%），1 例术后部分乳头坏死、脱落。1 例术后出现血肿，于术后3 个月消失。术后给予常规化疗，随访5～48个月，除1 例患者术后2 年死于原发性肝癌，均无局部复发或远处转移。结论:对于早期乳腺癌行保留乳头、乳晕及部分乳房皮肤的乳腺癌改良根治术后即刻采用不同方法乳房再造，具有经济、整形效果好、显著减少患者乳房缺失造成的心理影响、提高生存质量等优点。术后不影响乳腺癌的辅助治疗和远期疗效，能同时满足肿瘤治疗和形体美容两个方面的要求，正逐渐被广大乳腺癌患者所接受。 

Immediate Breast Reconstruction in 24 Patients after Nipple-sparing Modified Radical Mastectomy of Breast Cancer

Objective: To explore the therapeutic effects of immediate breast reconstruction after modified radical mastectomy of breast cancer with nipple-areolar complex preservation and partial skin-sparing. Meth- ods- We studied 24 eady stage breast cancer patients who received immediate breast reconstruction after modified radical mastectomy with nipple-areolar complex preservation and partial skin-sparing. Nine patients had silicone prosthesis, 3 patients had transverse rectus abdominis myocutaneous flap (TRAM), and 12 pa-tients had silicone prosthesis combined with part of latissmus dorsi-myocutaneous flap (LDMF). The effects of breast reconstruction were evaluated according to objective and subjective criteria after surgery. Results: All of the 24 patients obtained successful breast reconstruction. The appearance of the reconstructed breast was perfect and the two sides seemed symmetrical. The aesthetic outcome was good in 23 patients and satisfacto-ry rate was up to 95.83%, and the subjective evaluation was up to 100%. Necrosis of part of the nipple was found in only one case. Hematoma appeared in one patient and vanished after 3 months. All patients received adjuvant chemotherapy after surgery. No local recurrence and distant metastasis occurred during the follow up period (5～48 months). One patient died of primary hepatic carcinoma at 2 years after surgery. Conclusion:Immediate breast reconstruction after modified radical mastectomy of breast cancer with preservation of nip-ple-areolar complex and partial skin-sparing is safe and effective for early stage breast cancer patients. The reconstructed breast is satisfactory. Breast reconstruction surgery is economical and can reduce patients' psy-chological pressure due to loss of the breast, and improve quality of life. Immediate breast reconstruction does not affect postoperative adjuvant therapy and long-term therapeutic effect. Breast reconstruction surgery has been gradually accepted by more and more eady stage breast cancer patients.