摘要：
Objective To explore the clinical application of subpectoral silicone implant associated with autologous fat grafting after tissue expansion,for breast reconstructions.Methods From Jan 2013 to Dec 2016,a total of 15 female patients were admitted to the plastic surgery department of the First Affiliated hospital of Fujian Medical University.They were after or were prepared to unilateral modified radical mastectomy.Patients were aged 18-50 years old,with the average of 33.5 years.There were 8casesofT1N0M0(T1micN0M0,n=1),3 cases ofT2N0M0,1 case of T2N1M0,1 case of T1N2M0,1 case of T2N2M0 and 1 case of T3N3Mo.A tissue expander was inserted beneath the posterior pectoralis major in first surgery.The cavity stripped range is greater than the expander around 1cm.The lowest position of the expander was determined according to the IMF of the other breast.The tissue expander was gradually filled intraoperatively and postoperatively periodically,until the expander exceeds 30％-50％ of the volume of the other breast.Three months later,as the soft tissue over the breast area has stretched enough,the expander was removed in a second operation and a permanent implant was inserted.Meanwhile,the autologous fat particles,harvested from thigh or abdomen,was centrifuged at 800×g for 3 minutes.Then it was injected into the subcutaneous and posterior pectoralis major space.And the other breast may be adjusted if necessary for symmetry.Results Fifteen patients was included in this study (immediately tissue expander implanted,n =8;delayed tissue expander implanted,n =7).All the expanders are round in shape.The interval between the two operations was 6-12 months,with an average of 7.4 months.The total salt-water solution injected was 310-450 ml per patient,with an average of 365 ml.The volume of breast implants was 180-280 ml.The injection volume of autologous fat was 65-230 ml,122.7 ml on average.All incisions healed well.The follow-up period was 1-3 years,with an average of 2 years.The reconstructed breasts were in a natural shape,with a slight drop and bilateral symmetry.According to Harris breast shape evaluation criteria,all reconstructed breasts were graded as excellent.Conclusions The permanent implant associated with autologous fat grafting after tissue expansion is alternative for breast reconstruction.%目的 探讨皮肤软组织扩张后,假体置入同期行自体脂肪颗粒移植术在乳腺癌改良根治术后乳房再造中的临床应用效果.方法 2013年1月至2016年12月,福建医科大学附属第一医院整形外科共收治15例单侧乳腺癌改良根治术后女性患者.年龄18～50岁,平均33.5岁.其中,T1NoM08例(其中1例为T1micNoMo)、T2NoM03例、T2N1M0 1例、T1N2M0 1例、T2N2Mo 1例、T3N3Mo1例.依据健侧乳房的基底径选择大小合适的圆形皮肤软组织扩张器,按术前设计在胸大肌后间隙置入扩张器,腔隙剥离范围大于扩张器底盘1 cm左右,依据健侧乳房下皱襞水平判断患侧扩张器置入的最低位置.术中及术后定期向扩张器注水,达对侧乳房体积后继续超量注水30％ ～50％,注水完成后维持3个月以上.完成扩张后根据健侧乳房的基底径、大小、形态及两侧乳房大小相近时的注水量并参考患者意愿,更换合适容积和形态的乳房硅凝胶假体.同期抽取患者大腿或腹部脂肪颗粒,800×g,离心3 mmin.在患侧皮下、胸大肌后呈放射状、多间隙、多隧道、多层次注射自体脂肪颗粒,同时根据对称性调整对侧乳房形态,尽量达到双侧对称.结果 本组15例,即刻置入扩张器8例,延期置入扩张器7例.置入的扩张器均为圆形.本组病例两次手术间隔时间为6～12个月,平均7.4个月.扩张器注水总量310～450 ml,平均365 ml.假体容积180～280 ml.自体脂肪的注射量65～230 ml,平均约122.7 ml.术后切口均一期愈合.随访时间1～3年,平均2年.再造乳房形态自然、略有坠感、双侧对称,按Harris乳房外形评价标准均为优.结论 对于乳腺癌改良根治术后的患者,扩张后假体置入同期脂肪移植乳房再造术后效果较好,是一种较为理想的乳房再造术式.
