Serratus Anterior Fascial Flap for Expander Coverage in Breast Reconstruction - Cosmetic Result Comparison on a Patient with Metachronous Breast Cancer

前鋸肌筋膜皮瓣用於組織擴張器覆蓋之乳房重建－異時性雙側乳癌之個案術後比較

陳瑋農(Jim Wei-Nung Chen) ； 林煌基(Huwang-Chi Lin) ； 林上熙(Shang-Hsi Lin) ； 鄭翠芬(Tsui-Fen Cheng) ； 謝承翰(Cheng-Han Hsieh)

《臺灣整形外科醫學會雜誌》 25卷3期 (2016/09) Pp. 242-250

摘要

背景：在組織擴張器乳癌重建術中，提供適當的義乳覆蓋組織可避免義乳外露及感染。前鋸肌筋膜皮瓣被考慮會是取代傳統手術中，單純以肌肉作為組織覆蓋物的新選擇。目的及目標：透過本案患者，我們期待可以了解乳房重建過程中，使用前鋸肌筋膜皮瓣合併胸大肌作為義乳覆蓋物，是否能帶來相較於傳統方式（前鉅肌合併胸大肌）更好的術後結果。材料及方法：本案患者於2008年曾接受左胸皮膚保留乳房切除術，續以舊式-使用胸大肌及前鋸肌覆蓋下側的技術進行組織擴張器乳房重建手術。2013年，患者右胸被診斷出新的乳癌病情。在進行皮膚保留乳房切除術後，將組織擴張器置放於胸大肌下，並使用前鋸肌筋膜皮瓣作其下緣及外側覆蓋。於右胸第二重建階段，同時進行左側乳房外觀改善。結果：透過雙側乳房的比較，明顯發現於組織擴張器及義乳之乳房重建術中，使用胸大肌合併前鋸肌筋膜皮瓣覆蓋義乳的方式，能提供更自然的乳房外觀，患者術後滿意度也增加。結論：在擴張器乳癌重建術中，使用前鋸肌筋膜皮瓣做為下外側組織移植覆蓋是快速簡單安全且有效的新方式；且此技術讓患者擁有更好的乳房外觀，也提升其自信心。

並列摘要

Background: In two-stage expander-based breast reconstruction, providing adequate tissue coverage of the prosthesis is important in order to prevent complications of extrusion, exposure and infection. As in the complete submuscular placement, the serratus anterior fascial flap can be a useful alternative to cover tissue expander and implant inferolaterally. Aim and Objectives: We would like to investigate whether the usage of the serratus anterior fascial flap to cover the prosthesis during the breast reconstruction may lead to a better cosmetic outcome and higher patient satisfaction as compared to the conventional method (pectoralis major muscle with serratus anterior muscle) on the contralateral breast of the same patient. Materials and Methods: A 43-year-old woman, whom had newly diagnosed of right breast cancer, received a skin-sparing mastectomy following by placement of tissue expander under subpectoral pocket and serratus anterior fascia inferolaterally in February of 2013. She was first diagnosed of left breast cancer and received a skin-sparing mastectomy following by a two-staged implant-based breast reconstruction with conventional surgical technique (using pectoralis major muscle with serratus anterior muscle flap) in May of 2008. During the second stage of breast reconstruction for her right breast, a revision was also performed to correct the poor result of the left breast, especially over the inferolateral border with inadequate projection and ptosis. Results: Usage of pectoralis major muscle with serratus anterior fascial flap can provide adequate inferior and lateral breast projection which in turn allows a more natural breast contour. The improvement in the cosmetic result and patient satisfaction is evident when comparing with the contralateral breast. Conclusion: The new surgical plan of using serratus anterior fascial flap is a fast, simple, safe and effective method of supplying inferolateral implant coverage in post-mastectomy expander-based breast reconstruction. Furthermore, this technique shows a reliable result with superior appearance and high patient satisfaction.

並列關鍵字

serratus anterior fascia ； breast reconstruction ； implant ； tissue expanderacellular dermal matrix