探讨应用大腿游离真皮脂肪瓣进行乳房重建的可行性。

2017年1月4日广西医科大学附属肿瘤医院乳腺外科收治了1例27岁罹患乳腺癌的未婚女性。患者已在外院施行乳房肿块活组织检查，经本院病理科会诊后诊断为右乳浸润性微乳头状癌，ER(＋，阳性率>90%)，PR(＋，阳性率>90%)，HER-2(－)，Ki67(＋，阳性率约30%)。术前超声检测患者乳房下极脂肪厚度为3.0 cm，大腿内侧脂肪厚度为4.5 cm。采取右侧乳腺癌保留乳房手术＋右侧腋窝淋巴结清扫术＋即刻股内侧游离真皮脂肪瓣乳房重建术，术中切取右大腿内侧近根部约5.0 cm×7.0 cm的皮瓣，去表皮化后进行塑形并缝合固定在胸大肌表面。将手术标本送病理检查，术后定期(术后第7天和第10天)行乳腺超声和MRI检查。

术后病理确诊为右乳腺浸润性微乳头状癌，前哨淋巴结活组织检查显示有转移癌(1/2)，其余Ⅰ～Ⅲ水平腋窝淋巴结均未见转移癌。术后超声检查提示右乳再造皮瓣与原皮下残留脂肪组织回声一致，无液性暗区，未见感染及缺血坏死，皮瓣成活。乳腺MRI显示：术区见脂肪组织填充，血运良好。患者术后第2天下床活动，第5天拔除2根引流管，第10天再造乳房形态良好，双侧基本对称，平卧与站立位均无外形改变或不适，供区皮肤瘢痕隐蔽，患者满意度极高。术后随访至2017年8月31日，患者乳房基本对称，形态良好，未见肿瘤复发、转移。

大腿游离真皮脂肪瓣移植可作为保留乳房手术后乳房局部凹陷畸形修复的一种个体化术式。

To explore the feasibility of breast reconstruction using thigh free dermal fat flap.

In January 4, 2017, a 27-year-old unmarried female patient with breast cancer was admitted to the Department of Breast Surgery, Affiliated Tumor Hospital of Guangxi Medical University. She previously underwent breast tumor biopsy in another hospital. In our hospital, she was pathologically diagnosed as having invasive micropapillary carcinoma in the right breast with ER (+ , >90%), PR (+ , >90%), HER-2 (-), Ki67 (+ , about 30%). Preoperative ultrasound showed that the fat thickness in the inferior part of the breast was 3.0 cm and the fat thickness in internal femoral region was 4.5 cm. The patient underwent the right breast conserving surgery plus right axillary lymph node dissection plus immediate breast reconstruction using internal femoral free dermal fat flap. A 5.0 cm × 7.0 cm flap was removed from the medial proximal root of the right thigh during the operation. After de-epidermidalization, the flap was shaped and fixed on the surface of the pectoralis major muscle. Surgical specimens were sent for pathological examination and the patient was examined by breast ultrasound and MRI on postoperative days 7 and 10.

Postoperative pathology confirmed invasive micropapillary carcinoma of the right breast. Sentinel lymph node biopsy showed metastatic carcinoma (1/2), while no metastatic carcinoma was observed in axillary lymph nodes of levels Ⅰ to Ⅲ. Postoperative ultrasound showed that the reconstructed flap had the same echo to the original subcutaneous residual adipose tissue in the right breast, without dark area of fluid, infection and ischemic necrosis, suggesting the survival of flap. The breast MRI showed that the surgical area was filled with adipose tissue and blood circulation was good. On postoperative day 2, the patient had out-of-bed activities. On postoperative day 5, two drainage tubes were removed. On postoperative day 10, the reconstructed breast had good shape, bilateral symmetry, no appearance change or discomfort in the supine position and standing position. Moreover, the scar was occult in donor area. She was satisfied with clinical outcome. She was followed up until August 31, 2017. The follow-up showed good shape and bilateral symmetry of breasts, without recurrence or metastasis of breast cancer.

The transplantation of thigh free dermal fat flap can be used as an individualized surgical method for the repair of local breast deformity after breast conserving surgery.