Skin-Sparing Mastectomy with Immediate Breast Reconstruction Using Free Deep Inferior Epigastric Perforator Flap

皮膚保留乳房切除術後立即以自由式深下腹動脈穿透枝皮瓣重建乳房

黃綺烽(Chi-Feng Huang) ； 鄭明輝(Ming-Huei Cheng) ； 陳煥棠(Samuel H.T. Chen) ； 魏福全(Fu-Chan Wei) ； 陳訓徹(Shin-Cheh Chen) ； 羅永豐(Yung-Feng Lo) ； 葉大森(Ta-Sen Yeh) ； 趙子傑(Tzu-Chieh Chao)

《中華民國整形外科醫學會雜誌》 13卷4期 (2004/12) Pp. 244-252

https://doi.org/10.7096/JPSA.200412.0244

摘要

因為擔心增加腫瘤復發的機會，皮膚保留乳房切除術合併立即重建乳房仍尚未廣泛的被病人接受。本研究主要的目的在探討以皮膚保留乳房切除術後立即以自由式深下腹動脈穿透枝皮瓣重建乳房的腫瘤安全性，併發症及結果。
2000年6月至2002年9月期間，在林口長庚醫院共有34位乳房癌病患接受皮膚保留乳房切除術後，立即以自由式深下腹動脈穿透枝皮瓣來重建乳房。平均年齡為44.3歲。AJCC病理腫瘤的分期分別為零期癌5例，第一期癌13例，第二期癌16例。成功率為百分之百。無腹部皮瓣壞死，但有2例(5.9%)胸部皮瓣部分壞死。2例(5.9%)乳房傷口感染及1例(2.9%)腹部肚臍傷口感染。4例(11.7%)於皮瓣外側部份脂肪壞死。在為期平均31.2個月的追蹤當中，有1例(2.9%)於術後20週後產生腫瘤復發，病患目前仍存活中。皮膚保留乳房切除術並不會增加局部腫瘤復發的風險，也不會增加本身胸部皮瓣壞死機率。以自由式深下腹動脈穿透枝皮瓣來重建乳房提供較少的供應區傷害，較佳的外觀及較少的併發症。合併皮膚保留乳房切除術及自由式深下腹動脈穿透枝皮瓣來重建乳房是一個不錯的選擇。

並列摘要

Skin-sparing mastectomy (SSM) with immediate breast reconstruction is still not widely accepted because of concerns about the possible increasing risk of tumor recurrence and native skin necrosis. The objective of this study was to investigate the oncological safety, complication and outcome in a series of breast cancer patients who underwent SSM and immediate breast reconstruction by using free deep inferior epigastric perforator (DIEP) flap.
From June 2000 to September 2002, 34 consecutive patients underwent such approaches at Chang Gung Memorial Hospital. Mean age of patients was 44.3 years. According to American Joint Committee on Cancer (AJCC) staging system, the clinical stage was stage 0 in 5 patients, stage Ⅰ in 13 patients and stage Ⅱ in 16 patients. The flap survival rate was 100%. No abdominal skin flap necrosis was noted but 2 (5.9%) patients developed partial native chest skin flap necrosis. Two (5.9%) patients had minor breast wound infection and 1 (2.9%) patient had periumbilical wound infection. 4 (11.7%) patients had fat necrosis over the lateral flap area. At a mean follow up of 31.2 months, 1 patient got local recurrence 20 months after operation and is still living well at present.
SSM does not increase the risk of local recurrence and the risk of native skin flap necrosis. The free DIEP flap is a good option for breast reconstruction. The aesthetic result is superior, the complication rate is lower and donor site morbidity is not significant. Therefore SSM and immediate free DIEP flap is a viable option for earlier breast cancer treatment in properly selected patients.

並列關鍵字

skin-sparing mastectomy ； free deep inferior epigastric perforator (DIEP) flap ； breast reconstruction