组织工程与重建外科杂志 ›› 2023, Vol. 19 ›› Issue (2): 152-.

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乳房再造术中的假体选择策略

  

  • 出版日期:2023-04-01 发布日期:2023-05-09

Prosthesis selection strategy in breast reconstruction

  • Online:2023-04-01 Published:2023-05-09

摘要:

目的 探讨乳房再造术中的假体选择策略。方法 回顾分析 2006 年 8 月至 2021 年 8 月,在我院行乳腺癌
切除术后单侧假体乳房再造的 217 例患者的相关资料,总结围手术期各环节针对最终假体型号选择的经验,包括利
用三维体表成像技术对健侧乳房进行测量、乳癌术中记录切除组织体积、在扩张器 / 假体两阶段再造方法中记录双
侧乳房体积相近时的注水体积量、术中利用假体试模完成假体置入前的形态和体积验证等。术后从乳房下皱襞位置、
乳房突度以及乳房容量三方面评价再造乳房的美学效果。结果 本组中,行即刻乳房再造 164 例,延期再造 53 例 ;
行术后即刻假体置入 41 例,行扩张器 / 假体两阶段再造 176 例。组织扩张中位周期为 7.0(5.5,10.4)个月。应用
解剖形假体 189 例,圆形假体 28 例,假体体积中位数为 225(200,270)
mL。术后随访中位周期为 7.0(5.0,12.0)
个月。再造乳房美学评价为“优”者占 75.1%(163/217),绝大部分患者假体包膜挛缩分级为Ⅰ级或Ⅱ级(168/217,
77.4%)。结论 围手术期各环节均能够为最终假体型号的选择提供重要的参考信息,正确选择假体可使再造乳房达
到和健侧乳房较为对称的体积容量、乳房突度以及下皱襞位置,更易获得满意的美学效果。

关键词:

Abstract:

Objective To investigate the selection strategy of the prosthesis in breast reconstruction. Methods Two hundred and seventeen patients, who underwent unilateral implant-based breast reconstruction post-mastectomy from August 2006 to August 2021, were involved in this study, and the relevant information was reviewed and analyzed. The experience for the final prosthesis selection in each step during the perioperative period was summarized, including measuring the volume of the contralateral breast with the three-dimensional surface imaging technique, recording the volume of the resected tissue during breast mastectomy, recording the volume of the water injection when both sides of breasts got approximately the same volume during the expansion period, and using the sizer to verify the shape and volume before the permanent implant insertion during the surgery.
The cosmetic outcome was evaluated from three aspects, including the inframammary fold position, the protrusion and the volume of the breast. Results One hundred and sixty-four patients underwent immediate breast reconstruction, fifty-three were
provided delayed breast reconstruction, forty-one were applied immediate prosthesis insertion and one hundred and seventy-six
were applied tissue expansion/implant two-stage breast reconstruction. The median period of tissue expansion was 7.0 (5.5, 10.4)
months. One hundred and eighty-nine used anatomic prostheses and twenty-eight utilized round prostheses. The median volume
of prostheses was 225 (200, 270) mL. The median follow-up period was 7.0 (5.0, 12.0) months. Most of the patients (163/217,
75.1%) had“good”appearance evaluation, and most of the patients had capsular contracture grade Ⅰor Ⅱ(168/217, 77.4%).
Conclusion All steps during the perioperative period could provide important reference information for the selection of the
final prosthesis. Proper selection of the prosthesis could achieve symmetry to the contralateral breast in the aspects of volume,
protrusion and inframammary fold position, which make it easy to obtain satisfying reconstruction outcome.

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