乳腺癌术后一期假体置入乳房再造与美学塑形(1)
[摘要]目的:探讨如何将乳房美学运用于乳腺癌术后一期假体置入乳房再造,以便获得良好的外观效果。方法:实施一期假体置入乳房再造时,注重把修复再造和美学塑形结合起来,手术要点:向下游离胸大肌止点及部分腹直肌前鞘深面,以便形成与健侧基本对称的乳房下皱襞;外侧游离前锯肌,形成前锯肌瓣,并与胸大肌外缘缝合,使乳房假体置于完整的肌后腔隙,既可有效避免假体移位,又可突显乳房外侧弧度美。结果:21例乳腺癌患者应用此方法行一期假体置入乳房再造,优14例,良6例,一般1例。优良率为95.2%。结论:实施一期假体置入乳房再造时,只有将修复再造和美学塑形结合起来,才能再造出具有良好外形和质感的乳房,使患者满意。
[关键词]乳腺癌;乳房再造;美学
[中图分类号]R655.8[文献标识码]A[文章编号]1008-6455(2010)01-0004-03
Immediate breastreconstruction with implants for breast cancer and aesthetic shaping
, 百拇医药
LUO Jian-guo,FU Jian-min,CHEN Shao-jun,LIANG Na
(Department of Plastic Surgery,Shenzhen Maternity and Child Health Care Hospital of Southern Medical University, Shenzhen 518048,Guangdong,China)
Abstract:ObjectiveTo explore ways to apply breast aesthetic to immediate breast reconstruction with implants for breast cancer, so that favorable appearance could be seen.MethodsCarry out the immediately reconstructive breast surgery with implants with the emphasis on the combination of reconstructive repair and aesthetic shaping. The essential of surgery: Down dissociate the dead point of pectoralis major and part of the pre-sheath of rectus abdominis to form the basically symmetrical inframammary fold as the healthy side. Outside dissociate the serratus anterior to form the flap, and suture with the margin of pectoralis major. With the above steps, not only the implants shift could be prevented effectively, but also the outside aesthetic radian of the breasts could be stood out.ResultsThis immediately reconstructive breast surgery was completed in 21 breast cancer patients. We obtained 14 Excellent result cases, 6 Satisfactory ones, and 1 ordinary ones. The acceptance rate was 95.2%. ConclusionOnly if we combine the reconstructive repair and aesthetic shaping together during the immediately reconstruction surgery with implants will the patients be satisfied with the breasts with perfect appearance and texture.
, 百拇医药
Key words:breast cancer; breast reconstruction; aesthetics
乳腺癌术后一期乳房再造的方法有乳房假体置入和自体组织移植两大类。前者手术简便易行,不增加额外的手术瘢痕,病人痛苦少,易于接受。目前,如何把修复再造和美学塑形两者结合起来,以进一步改善再造乳房的外形,越来越被大家所重视。我科自2006年起开始实施乳腺癌术后一期假体置入乳房再造,注重将乳房美学运用于手术中,取得了良好的效果。现报道如下。
1资料和方法
本组21例均为单侧乳腺癌,其中左侧12例,右侧9例,均保留乳头乳晕。有18例肿瘤表面皮肤予以切除,另外
3例因肿瘤直径小于1cm,且不在腺体表面,肿瘤表面皮肤予以保留。
1.1 病例选择:肿瘤直径≤3cm,且与胸肌及表面皮肤无粘连。乳头乳晕部检查无癌浸润征象,且乳头无内陷固定、无溢液,糜烂、破溃。同侧腋窝无明显肿大的淋巴结,单发可推动肿大淋巴结不列为禁忌。为考虑术后两侧乳房基本对称,双侧乳房明显下垂而不愿意行健侧乳房提吊术者,肿瘤距乳头较近需切除乳头乳晕者,均不在本组病例选择之列。
, 百拇医药
1.2 手术方法
1.2.1 实施全麻,手术在可调节的手术台上进行,取平卧位,双上肢外展,标出双乳下皱襞曲线。
1.2.2 如需切除肿瘤表面皮肤,一般选择横梭形切口。如保留肿瘤表面皮肤,一般选择外侧纵向弧形切口。
1.2.3 行全乳腺切除,并行同侧腋窝淋巴结清扫。多点切取乳头乳晕基底组织送冰冻切片检查,结果阴性才能保留乳头乳晕。对于保留肿瘤表面皮肤者,也需切取该处皮下组织送切片检查,排除癌细胞浸润。
1.2.4 将胸大肌拉起,清扫胸肌间淋巴结,注意保护好胸肩峰血管。用电刀细心分离胸大肌后间隙,向内至胸骨旁线,向下游离胸大肌止点及部分腹直肌前鞘深面,达到或略超过原乳房下皱襞曲线。
1.2.5 用电刀沿肋骨面适当分离前锯肌,使之形成前锯肌瓣。
, 百拇医药
1.2.6 将手术台调至半坐位,于胸肌间置入假体(体积根据健侧乳房大小而定),将前锯肌瓣与胸大肌外侧缘缝合固定,并于假体上方的胸肌间缝合两针,防止假体上移.
1.2.7 胸壁及腋下各置负压引流管引流。
2术后外观评价标准
采用Harris评价标准[1]。优:再造乳房与健侧乳房大小基本相等,位置对称,患者非常满意;良:再造乳房与健侧乳房大小位置相差不多。着装后双乳房无明显差别,患者较满意;一般:双侧乳房明显不对称,着装后双乳差别明显,患者不满意;差:再造乳房严重变形。
3结果, http://www.100md.com(罗建国 傅建民 陈少君 梁 娜)
[关键词]乳腺癌;乳房再造;美学
[中图分类号]R655.8[文献标识码]A[文章编号]1008-6455(2010)01-0004-03
Immediate breastreconstruction with implants for breast cancer and aesthetic shaping
, 百拇医药
LUO Jian-guo,FU Jian-min,CHEN Shao-jun,LIANG Na
(Department of Plastic Surgery,Shenzhen Maternity and Child Health Care Hospital of Southern Medical University, Shenzhen 518048,Guangdong,China)
Abstract:ObjectiveTo explore ways to apply breast aesthetic to immediate breast reconstruction with implants for breast cancer, so that favorable appearance could be seen.MethodsCarry out the immediately reconstructive breast surgery with implants with the emphasis on the combination of reconstructive repair and aesthetic shaping. The essential of surgery: Down dissociate the dead point of pectoralis major and part of the pre-sheath of rectus abdominis to form the basically symmetrical inframammary fold as the healthy side. Outside dissociate the serratus anterior to form the flap, and suture with the margin of pectoralis major. With the above steps, not only the implants shift could be prevented effectively, but also the outside aesthetic radian of the breasts could be stood out.ResultsThis immediately reconstructive breast surgery was completed in 21 breast cancer patients. We obtained 14 Excellent result cases, 6 Satisfactory ones, and 1 ordinary ones. The acceptance rate was 95.2%. ConclusionOnly if we combine the reconstructive repair and aesthetic shaping together during the immediately reconstruction surgery with implants will the patients be satisfied with the breasts with perfect appearance and texture.
, 百拇医药
Key words:breast cancer; breast reconstruction; aesthetics
乳腺癌术后一期乳房再造的方法有乳房假体置入和自体组织移植两大类。前者手术简便易行,不增加额外的手术瘢痕,病人痛苦少,易于接受。目前,如何把修复再造和美学塑形两者结合起来,以进一步改善再造乳房的外形,越来越被大家所重视。我科自2006年起开始实施乳腺癌术后一期假体置入乳房再造,注重将乳房美学运用于手术中,取得了良好的效果。现报道如下。
1资料和方法
本组21例均为单侧乳腺癌,其中左侧12例,右侧9例,均保留乳头乳晕。有18例肿瘤表面皮肤予以切除,另外
3例因肿瘤直径小于1cm,且不在腺体表面,肿瘤表面皮肤予以保留。
1.1 病例选择:肿瘤直径≤3cm,且与胸肌及表面皮肤无粘连。乳头乳晕部检查无癌浸润征象,且乳头无内陷固定、无溢液,糜烂、破溃。同侧腋窝无明显肿大的淋巴结,单发可推动肿大淋巴结不列为禁忌。为考虑术后两侧乳房基本对称,双侧乳房明显下垂而不愿意行健侧乳房提吊术者,肿瘤距乳头较近需切除乳头乳晕者,均不在本组病例选择之列。
, 百拇医药
1.2 手术方法
1.2.1 实施全麻,手术在可调节的手术台上进行,取平卧位,双上肢外展,标出双乳下皱襞曲线。
1.2.2 如需切除肿瘤表面皮肤,一般选择横梭形切口。如保留肿瘤表面皮肤,一般选择外侧纵向弧形切口。
1.2.3 行全乳腺切除,并行同侧腋窝淋巴结清扫。多点切取乳头乳晕基底组织送冰冻切片检查,结果阴性才能保留乳头乳晕。对于保留肿瘤表面皮肤者,也需切取该处皮下组织送切片检查,排除癌细胞浸润。
1.2.4 将胸大肌拉起,清扫胸肌间淋巴结,注意保护好胸肩峰血管。用电刀细心分离胸大肌后间隙,向内至胸骨旁线,向下游离胸大肌止点及部分腹直肌前鞘深面,达到或略超过原乳房下皱襞曲线。
1.2.5 用电刀沿肋骨面适当分离前锯肌,使之形成前锯肌瓣。
, 百拇医药
1.2.6 将手术台调至半坐位,于胸肌间置入假体(体积根据健侧乳房大小而定),将前锯肌瓣与胸大肌外侧缘缝合固定,并于假体上方的胸肌间缝合两针,防止假体上移.
1.2.7 胸壁及腋下各置负压引流管引流。
2术后外观评价标准
采用Harris评价标准[1]。优:再造乳房与健侧乳房大小基本相等,位置对称,患者非常满意;良:再造乳房与健侧乳房大小位置相差不多。着装后双乳房无明显差别,患者较满意;一般:双侧乳房明显不对称,着装后双乳差别明显,患者不满意;差:再造乳房严重变形。
3结果, http://www.100md.com(罗建国 傅建民 陈少君 梁 娜)