侧胸壁脂肪筋膜肌肉瓣在乳腺癌术后即刻乳房成形中的应用

目的:探讨保留乳头乳晕复合体(NAC)的乳腺癌改良根治术后应用侧胸壁脂肪筋膜肌肉瓣即刻乳房成形的适应证、疗效及可行性。方法:对43例扁平或小乳房、IIIA期前的乳腺癌患者行保留NAC的乳腺癌改良根治术,术中即刻应用侧胸壁脂肪筋膜肌肉瓣乳房成形或同时联合假体乳房重建,术后评价美容效果,观察并发症,对治疗效果进行随访。结果:43例患者均成功手术。平均手术时间1.7(1.3~2.2)h,平均住院时间17(13~24)d,术后平均住院时间13(10~18)d。术后随访2~12个月,无乳头坏死,组织瓣感染2例;无局部复发及远处转移;患者总体满意度8.5分,乳房外观客观评价良好率86.0%(37/43)。结论:保留NAC的乳腺癌改良根治术后即刻应用侧胸壁脂肪筋膜肌肉瓣修复重塑乳房外形具有操作方便、手术快捷、技术可行的特点,特别适合于扁平小乳房、IIIA期前的乳腺癌患者。

Application of lateral thoracic subcutaneous-fascial-muscular flap for immediate mammoplasty after breast cancer surgery

Objective: To investigate the indication, efficacy and feasibility of using lateral thoracic subcutaneous-fascial-muscular flap for immediate mammoplasty after modified radical mastectomy with nipple-areola complex (NAC) preservation. Methods: Forty-three patients with flat or small breasts and pre-stage IIIA breast cancer underwent NAC preserving modified radical mastectomy followed by immediate mammoplasty with lateral thoracic subcutaneous-fascial-muscular flap or combined breast reconstruction with prosthesis. The postoperative cosmetic results and complications were evaluated, and the therapeutic effects were assessed by follow-up exam. Results: Operation was successfully performed in all the 43 patients. The average operative time was 1.7 (1.3-2.2) h, average length of overall hospital stay was 17 (13-24) d and average length of postoperative hospital stay was 13 (10-18) d. Postoperative follow-up was performed for 2-12 months, no nipple necrosis occurred and flap infection occurred in two cases; no local recurrence or distant metastasis occurred. The overall patient satisfaction score was 8.5 and the excellent and good rate for objective assessment of breast appearance was 86% (37/43). Conclusion: Using lateral thoracic subcutaneous-fascial-muscular flap for immediate mammoplasty after NAC preserving modified radical mastectomy has the feature of easy performance, short operative time and technical feasibility. It is especially suitable for patients with flat or small breasts and pre-stage IIIA breast cancer.