Simultaneous Contralateral Breast Reduction with Breast Reconstruction Using DIEP/SIEA Flap

使用深下腹動脈穿通枝皮瓣作乳房重建術中同時進行對側乳房縮小手術

馮中和(Chung-Ho Feng) ； 鄭明輝(Ming-Huei Cheng) ； 烏魯莎(Betul Gozel Ulusal) ； 陳廣得(Kuang-Te Chen)

《中華民國整形外科醫學會雜誌》 15卷4期 (2006/12) Pp. 315-321

https://doi.org/10.7096/JPSA.200612.0315

摘要

治無論在組織容量、大小和柔軟度方面，下腹部皮瓣組織是自體組織重建乳房的第一選擇。雖然在亞洲女生中乳房過度增生並不常見，但對某些須重建卻擁有對側過大乳房的病人，要做到對稱且令人滿意的乳房重建，對整形外科醫師而言仍是很大的挑戰。
從2000年3月到2005年4月間，有7位乳房重建病人對側乳房過大，其中二人分二期手術，其他5人中有4人同時接受深下腹動脈穿通枝皮瓣重建和對側乳房縮小手術，另一人接受淺下腹動脈穿通枝皮瓣乳房重建和對側乳房縮小手術。這五位同時做乳房重建和對側乳房縮小的病人平均年齡48歲（38-67歲），都是延遲性的重建，且自由皮瓣都成功存活。另外對側乳房縮小後並沒有胸壁皮膚壞死和感染，平均開刀時間10.5小時（9-12小時）。在平均12個月（3-36個月）的追蹤治療，對側縮小後的乳房都和自由皮瓣重建後的乳房呈現對稱且令人滿意的乳房，其中4位病人穿C罩杯，另一人穿D罩杯的胸罩。其中二位病人雙側乳房疤痕有過度增生的現象，但病人都能接受，五位病人都有很好的滿意度。
總之，同時以深下腹動脈通枝或淺下腹動脈皮瓣作乳房重建，和對側乳房縮小手術，對於需乳房重建且對側乳房過大的病人可提供令人在功能上及外觀上滿意的效果，且非常少發生供應區的後遺症，雖然麻醉時間長，且要擁有顯微手術的技巧，但初步結果是肯定的。

並列摘要

The low abdominal adipose tissue is the first choice for autologous tissue transplantation for breast reconstruction in term of tissue volume, size and softness.
Although the hyperplastic breasts are not common in Asian women, it remains a challenge for the plastic surgeons to reconstruct a symmetric and pleasing breast for some patients with hyperplastic contralateral breast.
Between 2000 March and April 2005, there were consecutive 7 patients with hyperplastic contralateral breast underwent breast reduction. Two patients received breast reconstruction at separate stage from the breast reconstruction. Four of 5 patients received simultaneous contralateral breast reduction with DIEP flaps for breast reconstruction, and one patient with SIEA flap, respectively. The average age of 5 simultaneous contralateral breast reduction patients was 48 years(ranged 38-67 years).
All 5 breast reconstructions were delay reconstruction. Four DIEP flaps and one SIEA flap were successful. The contralateral breast reduction went well without partial chest wall flap loss, and infection. The average operation time was 10.5 hours(ranged from 9 to 12 hours). At a mean 21-months(ranged 3-36 months)of follow-up, the contralateral reduced breast presented a pleasing shape and symmetric to the reconstructed breast using DIEP flap or SIEA flap. Four patients wear with Cup C bra and one with Cup D bra. Two of 5 patients presented with hypertrophic scars at both the reduced and reconstructed breasts, that were acceptable by the patients. The aesthetic satisfaction was on excellent score in 5 patients.
In summary, simultaneous contralateral breast reduction may provide functional and aesthetic achievement for hyperplastic breast as well as minimal donor site morbidity in the breast reconstruction using DIEP or SIEA flap. Although these procedures may prolong the operation time and require the microsurgical techniques, the preliminary results of simultaneous breast reduction in breast reconstruction are promising.

並列關鍵字

breast reduction ； symmetry procedure ； breast reconstruction ； DIEP flap ； SIEA flap