组织外扩张辅助自体脂肪移植乳房再造术

摘要

Objective To investigate the application and therapeutic effect of external tissue expansion-assisted autologous fat grafting for delayed breast reconstruction.Methods Patients began wearing the BRAVA negative pressure system 8 hours a day for recipient tissue expansion for one month before the fat grafting procedure.After fat grafting,BRAVA was recommended to be worn 8 hours a day from postoperative 48 hours to one month.The interval of each fat grafting procedure was 2.5 to 3.0 months.The procedures were repeated until the completion of breast reconstruction.Water-jet assisted liposuction and subcutaneous release of scars were also performed during surgery.Results From January 2013 to November 2016,29 patients were followed up for 12 to 58 months,with average of 31.6 months.28 patients completed the external tissue expansion-assisted autologous fat grafting breast reconstruction.Completion required 1 to 6 procedures,with average of 3.4 procedures.The total initial fat fill volume for each breast was ranged from 200 to 1 000 ml,with average of 583.7 ml.The initial fat fill volume for each breast was ranged from 92.5 to 243.7 ml per operation,with average of 173.8 ml.One patient underwent latissimus dorsi myocutaneous flap breast reconstruction after 3 fat grafting procedures.8 patients completed the inframammary fold reconstruction,3 patients underwent breast lift,1 patient underwent lipofilling augmentation for the contralateral side.Postoperative satisfaction rate was 82.8％ in patients and 75.9％ in surgeon.Complication statistics:5 cases of palpable nodules which recognized as fat necrosis (17.2％),one case of nontuberculous mycobacterial infection (3.4％) and one case of locoregional cancer recurrence (3.4％).Conclusions External tissue expansion-assisted autologous fat grafting is a minimally invasive procedure for breast reconstruction.Satisfactory results could be obtained for most of the patients who would like to choose fat grafting and have enough fat deposit in other parts of the body.%目的 探讨组织外扩张辅助自体脂肪移植技术用于延期乳房再造的应用方法和治疗效果.方法 患者于脂肪移植术前1个月开始佩戴组织外扩张负压系统(BRAVA)进行受区组织扩张,8 h/d术后48 h继续佩戴BRAVA,8 h/d,持续1个月.每次脂肪移植间隔2.5 ～3.0个月,重复上述过程,直到完成乳房再造.术中联合应用水动力辅助吸脂技术及皮下瘢痕松解技术.结果 2013年1月至2016年11月于临床应用29例,随访12～58个月,平均31.6个月.其中28例顺利完成组织外扩张辅助自体脂肪移植乳房再造,注射脂肪1～6次,平均3.4次;单只乳房脂肪注射总量200 ～1 000 ml,平均583.7 ml;单只乳房单次手术脂肪注射量92.5～243.7 ml,平均173.8 ml.1例在3次脂肪移植术后改以背阔肌肌皮瓣行乳房再造.8例行再造乳房下皱襞成形术,3例行健侧乳房上提术,1例行健侧乳房脂肪隆乳术.术后效果患者满意率82.8％,手术医生满意率75.9％.术后并发症统计:脂肪坏死形成可触及结节5例(17.2％),非结核分支杆菌感染1例(3.4％),乳腺癌复发1例(3.4％).结论 组织外扩张辅助自体脂肪移植技术是一种微创化乳房再造方法,对于绝大多数自愿选择脂肪移植且身体其他部位有多余脂肪的患者,能够获得令人满意的效果.