目的

探讨乳头乳晕区乳腺癌术后即刻乳房重建的方法及临床应用。

方法

回顾性分析天津医科大学肿瘤医院乳腺一科2004年1月至2007年12月共15例乳头乳晕区乳腺癌患者，其中0期乳腺癌3例，Ⅰ期乳腺癌7例，Ⅱ期乳腺癌5例。15例患者中13例行乳头乳晕区圆形切口的保乳手术（标本切缘阴性）后即刻背阔肌皮瓣重建术，2例拟行乳头乳晕区圆形切口的保乳手术，因标本切缘阳性，改行仿根治术，术后行即刻背阔肌皮瓣加假体植入乳房重建术。15例患者中即刻乳头乳晕重建术9例，延期乳头乳晕重建术2例，拒绝乳头乳晕重建4例。

结果

13例保乳加背阔肌皮瓣重建患者中12例外形满意，满意率为92.31%，1例缝合后中央区内陷，外形不满意，但大小与健侧对称。2例背阔肌皮瓣联合假体重建乳房外形满意。9例即刻重建乳头乳晕7例成活，2例发生重建乳头部分坏死；3例乳头位置略高于健侧。2例延期乳头乳晕重建均成活，且位置对称。15例中6例发生背部皮下积液，1例背部切口裂开。随访10～48个月，中位随访时间25个月，1例患者出现切口局部复发，复发率为7.69%，无远处转移发生。

结论

对乳头乳晕中央区乳腺癌进行保乳手术加即刻背阔肌皮瓣重建术可以提高术后乳房外形满意率，且可行即刻乳头乳晕重建术。保乳手术后局部复发率和远处转移率与根治术无差异。

Objective

To study clinical application and methods of immediate breast reconstruction for subareolar breast carcinomas.

Methods

Fifteen cases with subareolar breast cancer were retrospectively analyzed from Jan 2004 to Dec 2007 at the First Department of Breast Surgery，Cancer Hospital，Tianjin Medical University.Three cases were 0 stage，7 casesⅠstage and 5 casesⅡstage.Among the 15 cases，13 were treated with breast conserving therapy plus immediate breast reconstruction with latissimus dorsi musculocutaneous（LDM）flap using periareolar incision under the condition of negative excision margin of samples by pathologic diagnosis of fast frozen sections；2 cases were treated with mastectomy plus immediate breast reconstruction with LDM flap and implant due to positive excision margin by pathologic examination of frozen sections.Nine cases accepted immediate nipple-areola reconstruction，2 cases accepted delayed nipple reconstruction and 4 cases refused nipple-areola reconstruction.

Results

Of the 13 cases treated with breast conserving therapy plus immediate reconstruction with LDM flap，12 were satisfied with postoperative results，and the satisfactory rate was 92.31%；1 patient was unsatisfied with her reconstructed breast due to central retraction，but it was symmetrical with the healthy breast.Two patients treated with LDM flap and implant reconstruction were satisfied with the results.Of the 9 cases with immediate nipple reconstruction 7 were alive and 2 had partial necrosis.In 3 cases the reconstructed nipple-areola was higher than that of the healthy side，whereas，2 cases with delayed nipple-areola reconstruction were satisfied with their results including the shape and position.Six out of 15 patients were complicated with dorsal subcutaneous edema and 1 case had dorsal incision cracking.The follow-up time varied from 10 months to 48 months，with average of 25 months.One case had recurrence at local incision but no metastasis，with the recurrence rate of 7.69%.

Conclusions

Breast conserving therapy plus immediate breast reconstruction with LDM flap for central breast carcinoma can raise the satisfactory rate of reconstructed breast contour，and immediate reconstruction of nipple-areola can be performed.There is no difference in local recurrence and distant metastasis compared with mastectomy.