Is It Safe for An Asian Woman To Be Pregnant after TRAM Flap Surgery for Breast Reconstruction?-A Case Report

接受過腹直肌肌皮瓣手術的婦女懷孕生子是否安全？個案報告

林運男(Yun-Nan Lin) ； 林幸道(Sin-Daw Lin) ； 賴春生(Chung-Sheng Lai) ； 張高評(Kao-Ping Chang) ； 侯明鋒(Ming-Feng Hou)

《臺灣整形外科醫學會雜誌》 21卷4期 (2012/12) Pp. 343-350

https://doi.org/10.7096/TJTSPS.201212.0343

摘要

背景：在台灣社會中乳癌是一個快速增加的疾病而族群也越來越年輕。腹直肌肌皮瓣重建手術（TRAM flap）是乳房切除術後最常使用的自體組織。但是隨著越來越多的女性在還沒懷孕生子前就已經被診斷出乳癌，對於術後的癒合的傷口是否能承受懷孕時增加的腹內壓是個值得探討的議題。目的及目標：我們提出一個28歲的女性她在重建手術後7年懷孕。在文獻上鮮少有亞洲女性的個案報告。相關的文獻有關腹直肌肌皮瓣手術跟深下上胃穿透枝皮瓣手術的個案報告，在文中有相關的討論。材料及方法：28歲的年輕女性被診斷為乳癌，接受了右側皮膚保留乳房切除手術與立即性左側腹直肌肌皮瓣重建手術，術中僅拿取中間三分之一的腹直肌當作血管莖，腹直肌供體處的缺口用2-0尼龍線將保留的外側和內側的肌肉跟筋膜對縫兩層，縫合時並沒有使用人工網膜加強。結果：術後和妊娠的過程平順並沒有後遺症發生，個案平安生產下一個漂亮的小女嬰。結論：腹直肌肌皮瓣重建乳房手術術後的婦女是可以在妊娠中平安順利生產的。

並列摘要

Background: Breast cancer is a thriving disease in Taiwan society and the population is more and more younger. Transverse rectus abdominis muscle flap (TRAM flap) reconstruction is the most common used autologous tissue after mastectomy. However, due to the increasing women who are diagnosed of breast cancer before pregnancy, it is a rising question about that the increasing intra-abdominal pressure could or could not compromise the healing scar. Aim and objective: We report a 28-year-old female who became pregnant 7 years after TRAM flap breast reconstruction surgery. This is the few case of Asian women of this kind. The literatures on cases pregnant after breast reconstructions of TRAM and DIEP breast reconstruction are reviewed. Materials and methods: This 28-year-old female was diagnosed of breast cancer and received right skin-sparing mastectomy and immediate breast reconstruction with left unilateral pedicled TRAM flap. During the procedure, only the central one third part of the rectus muscle was dissected and prepared as the vascular pedicle; the donor defect after dissection of the pedicle was closed securely by two layers sutures with 2-0 Nylon of the preserved lateral and medial strips of fascia and muscle. There was no use of mesh for the closure of the defect. Results: The post-operation course and gestation course of this case were unremarkable and no complications noted. She had a beautiful baby girl. Conclusions:Women who had TRAM flap breast reconstruction are capable of bearing a child during pregnancy and delivered smoothly.

並列關鍵字

breast reconstruction ； TRAM flap ； pregnancy