可扩张乳房假体加背阔肌肌皮瓣的乳房再造术

目的：报告应用带蒂背阔肌肌皮瓣转移术及可扩张的乳房假体（BECKER）置入,修复乳腺癌根治术后的胸壁畸形,同时再造乳房的手术方法。方法：根据乳腺癌病灶清除术后患者胸部的畸形状况,设计患侧带蒂背阔肌肌皮瓣的肌瓣长度、体积以及皮瓣的面积和形状,切取肌皮瓣后经腋部皮下隧道转移至胸前。用肌瓣修复胸前软组织缺损,皮瓣则用于弥补胸部皮肤的不足。肌瓣与胸壁间置入可扩张的乳房假体。术后经注射壶注水,逐步扩张至额定值。6个月后,可抽除注射壶并重建乳头,完成治疗。结果：自1999年以来,对各种乳腺癌术后患者行乳房再造术共26例,获得了满意效果。结论：应用带蒂背阔肌肌皮瓣转移术及可扩张的乳房假体置入,不仅可修复乳腺癌病灶清除术后的胸部软组织的缺损、锁骨下的凹陷畸形而且可重建乳房。该法具有创伤小、恢复快、再造乳房的外形及质感逼真等特点。

Breast reconstruction using latissmus dorsal myocutaneous flap with expandable breast implant

Objective To introduce our experience about breast reconstruction using pedicled latissmus dorsal myocutaneous flap with expandable breast implant (Becker mammary expander) to repair the deformity of the chest wall and reconstruct the missing breast after the surgery of breast cancer. Methods The flap was designed according to the deformity of the patient's breast and chest wall, and transferred to the anterior chest through the tunnel under the axillary skin. The muscle flap and the skin flap were used to repair the soft tissue and chest skin deficiency respectively. The expandable breast implant was put between the muscle flap and the chest wall, and filled after the surgery through the valve until the reconstructed breast was the same size as the opposite one. Six months later, the valve was removed and a nipple reconstruction was done. Results Since 1999, breast reconstruction using pedicled latissmus dorsal myocutaneous flap with expandable breast implant was performed in 26 cases. The outcomes were satisfying. Conclusion Using pedicle latissmus dorsal myocutaneous flap with expandable breast implant can not only repair the chest soft tissue deficiency and the concave deformity under the clavicle after the breast cancer surgery, but also reconstruct the breast. The advantages of this method are small trauma, rapid recovery and excellent contour of the reconstructed breast.