目的

探讨保留皮肤的乳腺癌改良根治术后即刻再造乳房的适应证、方法、效果及可行性。

方法

2002年1月至2007年11月本院对94 例乳腺癌患者行保留乳房皮肤皮下乳腺组织切除加腋窝淋巴结清扫术后,应用下腹部横行腹直肌肌皮瓣(transverse rectus abdominis myocutaneous flap,TRAM)、背阔肌肌皮瓣(latissimus dorsi myocutaneous flap,LDM)联合或不联合假体、单纯乳房假体植入4 种方式即刻再造乳房。

结果

再造手术均取得成功。 带蒂TRAM 再造47 例,LDM 再造共42 例(其中联合假体28 例),单纯乳房假体植入5 例。 4 例出现轻微术后并发症(4.25%)。 经过3 ～67 个月随访,局部区域复发率为0,再造乳房形态自然,效果满意,术后外观评价优良率97.87%。

结论

合理选择病例行保留皮肤或保留乳头乳晕乳腺癌改良根治术后即刻乳房再造是安全可靠的,切口隐蔽并能够保留原有乳房皮肤的感觉,从而获得最佳美容效果,值得广泛推广和应用。

Objective

To investigate the indications,surgical methods, effects and feasibility of immediate breast reconstruction after skin-sparing mastectomy.

Methods

From January 2002 to November 2007, 94 breast cancer patients received skin-sparing mastectomy plus axillary lymph node dissection and immediate breast reconstruction with transverse rectus abdominis myocutaneous flap(TRAM),latissimus dorsi myocutaneous flap(LDM)with or without implant and full-size implants.

Results

All reconstructions were successful. TRAM breast reconstruction was performed in 47 cases, LDM breast reconstruction in 14 cases,LDM plus implant breast reconstruction in 28 cases, and full-size implant breast reconstruction in 5 cases.Minor complications were recorded in 4 patients (4.25%).Aesthetic results were judged as good or fair in 97.87% patients. The morphology of reconstructed breasts was excellent. Locoregional recurrence was 0% by follow-up of 3 -67 months.

Conclusion

Immediate breast reconstruction after skin-sparing mastectomy is a safe and effective method for 0 -Ⅱ_A stage breast cancer patients, and good results can be obtained in breast shape, symmetry, skin colour, skin sensation and incision scar, without increase of local recurrence. This method is worth spreading and applying.