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目的探讨乳腺癌患者在行乳腺癌改良根治术(或根治术)的同时,实施几种保留乳房外形的美容手术方法。方法对不同分期的乳腺癌患者行改良根治术(或根治术)及Ⅰ期腹直肌肌皮瓣乳房再造术,或Ⅰ期假体置入重建并植皮术;对能保留乳头乳晕者行保留乳头乳晕复合体的乳腺癌改良根治术;对有生育要求的患者行改良根治术及背阔肌肌皮瓣转移乳房再造并假体置入术。结果行保留乳头乳晕复合体的改良根治术及Ⅰ期腹直肌肌皮瓣乳房再造术者8例,行Ⅰ期假体置入重建并植皮术者15例;行不保留乳头乳晕复合体的改良根治术及Ⅰ期腹直肌肌皮瓣乳房再造术者8例,Ⅰ期假体置入重建并植皮术者2例;行保留乳头乳晕复合体的改良根治术及背阔肌肌皮瓣转移乳房再造并假体置入术者2例。所有病例术后随访6～46个月,均无肿瘤局部复发及远处转移,1例根治术及腹直肌肌皮瓣转移乳房再造术后46个月对侧发生乳腺癌。重建乳房外形良好,乳房下皱襞弧度好,保留乳头乳晕区皮肤无坏死;皮肤无萎缩变硬,手感良好;腹部供区无腹壁疝形成,置入假体手感好,移植皮瓣无坏死。结论对不同分期的乳腺癌患者在治疗乳腺疾病的同时,采取多种Ⅰ期乳房重建术能最大限度地保留乳房外形的美观,是较好的治疗方法,在临床需大样本研究来推广。
Objective To investigate the methods of cosmetic surgery for breast cancer patients underwent modified radical mastectomy (or radical mastectomy) while maintaining breast appearance. Methods Modified radical mastectomy (or radical mastectomy) and stage I rectus myocutaneous myocutaneous reconstruction were carried out on patients with different stages of breast cancer, or stage I implants were reconstructed and skin grafted. Patients who could retain nipple and areola were reserved Nipple areola complex modified radical mastectomy; patients with fertility require modified radical mastectomy and latissimus dorsi muscle flap transfer breast reconstruction and prosthesis placement. Results The modified radical mastectomy with nipple areola complex and 8 cases with stage Ⅰ rectus myocutaneous myocutaneous reconstruction were performed. In stage I, 15 cases were treated with reconstruction and skin grafting. Modified radical mastectomy and stage Ⅰ rectus abdominis muscle flap Breast reconstruction in 8 cases, stage Ⅰ implant reconstruction and skin grafting in 2 cases; line retained nipple areola complex modified radical mastectomy and latissimus dorsi muscle flap Transfer breast reconstruction and prosthesis placement in 2 cases. All patients were followed up for 6 to 46 months, no local tumor recurrence and distant metastasis, 1 case of radical mastectomy and rectus abdominis muscle flap transfer 46 months after breast reconstruction contralateral breast cancer. Rebuild the breast good shape, breast fold under the arc is good, keep the nipple areola area without necrosis; no shrinkage of the skin hardening, feel good; abdomen for no abdominal hernia formation, implant prosthesis feel good, no necrosis of the graft flap. Conclusion Breast cancer patients with different stages of breast cancer in the treatment of breast disease at the same time, to take a variety of stage Ⅰ breast reconstruction to maximize the aesthetic appearance of breast shape retention is a better treatment, the clinical need to study a large sample to promote.