CAJ | 학술논문

目的探讨保留皮肤的乳癌改良根治术后,应用背阔肌肌皮瓣即刻行乳房及乳头再造术的可行性.方法 24例乳癌患者行保留皮肤的乳癌改良根治术后,应用背阔肌肌皮瓣联合或不联合乳房假体,即刻行乳房再造术,并利用背阔肌肌皮瓣皮岛设计改良箭头皮瓣,同时行乳头再造术.结果 2例再造乳头出现部分坏死,坏死面积分别为10％和6％,均经换药后愈合.所有患者均在术后6、12个月进行随访,再造乳头平均回缩率分别为35.4％、38.6％.随访12个月,3例出现假体包膜挛缩(Baker Ⅰ级),未行手术修整.91.7％的患者对乳房形状非常满意和满意,83.3％对乳房体积非常满意和满意,100％对乳头形状非常满意和满意,91.6％对乳头突度非常满意和满意.91.7％的患者认为即刻乳头再造非常重要,无患者认为即刻乳头再造不重要;66.7％的患者认为再造乳房完全替代了原有乳房,25％的患者认为可以部分替代原有乳房.结论保留皮肤的乳癌改良根治术后,应用背阔肌肌皮瓣即刻行乳房及乳头再造术,可获得良好的美学效果.
목적 탐토보류피부적유암개량근치술후,응용배활기기피판즉각행유방급유두재조술적가행성.방법 24례유암환자행보류피부적유암개량근치술후,응용배활기기피판연합혹불연합유방가체,즉각행유방재조술,병이용배활기기피판피도설계개량전두피판,동시행유두재조술.결과 2례재조유두출현부분배사,배사면적분별위10％화6％,균경환약후유합.소유환자균재술후6、12개월진행수방,재조유두평균회축솔분별위35.4％、38.6％.수방12개월,3례출현가체포막련축(Baker Ⅰ급),미행수술수정.91.7％적환자대유방형상비상만의화만의,83.3％대유방체적비상만의화만의,100％대유두형상비상만의화만의,91.6％대유두돌도비상만의화만의.91.7％적환자인위즉각유두재조비상중요,무환자인위즉각유두재조불중요;66.7％적환자인위재조유방완전체대료원유유방,25％적환자인위가이부분체대원유유방.결론 보류피부적유암개량근치술후,응용배활기기피판즉각행유방급유두재조술,가획득량호적미학효과.
Objective To investigate the feasibility of immediate breast and nipple-areola reconstruction after skin-sparing mastectomy.Methods 24 patients who received skin-sparing mastectomy underwent immediate breast reconstruction with or without breast implants.The nipple-areola complex is also reconstructed with the skin paddle of the latissimus dorsi flap in one stage.Results All the latissimus dorsi myocutaneous flaps survived completely.Partial necrosis happened in two reconstructed nipples which healed after dress changing.The follow-up period ranged from 6 to 12 months.3 patients presented with capsular contracture (Baker Ⅰ),with no necessary of surgical revision.The retraction rate of reconstructed nipples projection is 35.4％ at 6 months postoperatively and 38.6％ at 12 months postoperatively.91.7％ of patients were satisfied or very satisfied with the breast shape,while 83.3％ were satisfied or very satisfied with the breast volume.All the patients considered the reconstructed nipple very good,while 91.6％ were satisfied with the nipple projection.91.7％ considered immediate nipple reconstruction to be very important,and 8.3％ considered it to be important.66.7％ considered the new breast could replace the breast they had lost,and 8.3％ considered that it could not.Conclusion For skin-sparing mastectomy,immediate breast and nipple reconstruction can achieve good aesthetic results.