目的

介绍单纯应用扩大背阔肌肌皮瓣进行乳房再造的方法。

方法

将背阔肌周围脂肪组织分为5 个区，切取背阔肌及周围脂肪组织，不应用乳房假体，进行即时或延期乳房再造。

结果

应用该方法再造乳房261 例，其中保留乳头乳晕改良根治术后即时再造124 例，保留皮肤改良根治术后即时再造43 例，改良根治术后即时再造56 例，延期再造38 例；再造乳房均形态良好。 术后16 例出现乳头部分坏死；14 例胸部皮肤表皮脱落，自行愈合；2 例背部供区部分坏死；3 例发生背部顽固性血肿，再次手术后愈合。

结论

扩大背阔肌肌皮瓣乳房再造安全、有效，再造乳房形态良好，尤其适用于中、小乳房的乳房再造。

Objective

To introduce our experience about immediate and delayed breast reconstruction using extended latissimus dorsal myocutaneous flap without breast implant.

Methods

The fatty tissue around the latissimus dorsal muscle was classified into 5 zones. Breast reconstruction was performed with latissimus dorsal myocutaneous flap and surrounding fat tissue， without breast implant.

Results

Breast reconstruction was performed in 261 patients with extended latissimus dorsal myocutaneous flap， with 124 cases receiving immediate breast reconstruction after nipple sparing modified radical mastectomy，43 cases after skin sparing modified radical mastectomy and 56 cases after modified radical mastectomy， and the rest 38 cases receiving delayed breast reconstruction. The morphology of reconstructed breasts was excellent. After operation 16 cases had partial nipple necrosis， 14 cases had rhacoma of the chest， but cured automatically， 2 cases had necrosis on part of the donor side， and 3 cases had seroma on the back and cured by reoperation.

Conclusions

Breast reconstruction with extended latissimus dorsal myocutaneous flap is safe and effective，especially suitable to breast reconstruction with small and medium size breasts.