脂肪筋膜瓣乳房整形【可編輯的】課件

1、Adipofascial flap天津市腫瘤醫(yī)院乳腺一科陳祖錦11I 級級乳腺組織切除量少于20%不需要切除多余皮直接縫合無需乳房成形術適用于腺體致密的乳房不需要整形技術訓練乳腺組織切除量在2050%之間需要切除多余皮膚基于乳房成形術腺體致密或脂肪含量豐富的乳房均適用需要一定的專業(yè)整形技術訓練基于乳腺切除的量及手術相對難度將OPS分為兩級Volume Displacement用殘存乳腺組織進行美學重塑保乳術后乳房整形Volume Replacement用非乳腺織進行替代填充Volume replacement techniques Adipofascial flap Lateral thora

2、codorsal flapThoracoepigastric flap Intercostal artery perforator (ICAP)flap Thoracodorsal artery perforator (TDAP) flap Latissimus dorsi (LD) myocutaneous flapProcedure for harvesting the C-shaped thoracodorsal ap and repair of the defect. (A) By the same skin incision upon the middle axillary line

3、, we can do the partial resection of the breast, axillary lymph node dissection, and get the adipofascial ap. (B) A C-shaped thoracodorsal adipofascial ap was harvested after local resection of the breast and axillary lymph node dissection.(C) Attaching the fascia of the latissimus dorsi muscle to t

4、he adipose tissue makes the harvested tissue rm.(D) The ap is rotated to the medial sideto ll the defect. We sometimes roll or gather it to reconstruct to the breast mound.Thoracodorsal adipofascial ap 42-year-old lady with breast cancer located on upper outer-quadrant of the right breast (Case 1) (

5、A) A resected area of the breast with the gross margin as 3 cm and a C-shaped thoracodorsal adipofascial ap was marked before surgery. (B and C) 6 months post-surgery. The deformity of both breast and donor site is inconspicuous.6-year-old lady with breast cancer located on upper outer-quadrant of t

6、he right breast (Case 2). (A) A resected area of the breast with the gross margin as 3 cm and a C-shaped thoracodorsal adipofascial ap was marked before surgery. (B and C) 6 months post-surgery. The cosmetic result was excellent.Modied thoracodorsal adipofascial cutaneous ap.A 27-year-old woman with

7、 breast cancer located in the upper-outer quadrant of the right breast (Case 2). (A) A modied thoracodorsal adipofascial cutaneous ap was designed so that it could be harvested via an incision along the anterior axillary line and an additional back incision. (B)(C) Six months postsurgery. The bilate

8、ral incisions were inconspicuous from the anterior viewThe local ndings 1 year after the surgery Free dermal fat graft (FDFG) A 57-year-old patient with a slim body and non-ptotic breasts (case 2)(A) Preoperative findings;(B) An incision line was drawn in red across the nipple. A free dermal fat gra

9、ft (FDFG) from the lower abdomen was implanted in the cylinder-shaped deformity in the central breast; (C) Four years after surgery.A 58-year-old patient with Pagets disease in the right breast (case 3). (A) Preoperative findings; (B) An incision line was drawn in red. The nipple, but not the areola

10、 was removed together with the breast tissue. A free dermal fat graft (FDFG) from the lower abdomen was harvested for implantation into the breast defect (15,16); (C) Seven years after surgery. (a) In situ de-epithelialization of the entire skin paddle was performed. (b) An ellipse of fat and dermis

11、 was removed by sharp dissection. (c) The FDFG was turned over so that the dermis faced the surface of the pectoralis major and was xed securely along the entire periphery.Figure 5 Ultrasonography revealed good FDFG volume one year after the operation (F: FDFG, G: normal gland).Case 1: preoperative

12、markings of the area to be resected in a 53-year-old patient with a T1 tumor in the lower-outer quadrant of theleft breast. a A purple spot formed after core needle biopsy (CNB).Her breasts were not ptotic.b, c The cancer lesion and the scar in the 6 oclock position left by the CNB are circled in re

13、d. The incision line is drawn in red along the inframammary lineInframammary adipofascial apOperative ndings.a A tongue-shaped adipofascial ap,10 cm in length, was drawn as a black dotted line. A crescent of skin was de-epithelialized. b The ap was harvested via an inframammary incision line and a c

14、audal window.c The de-epithelialized skin was harvested together with the inframammary ap. d The tissue was rolled up towards the cranial sidea,b inferior adipofascial tissue repair Skin incision was placed on infra-mammary line.c. This flap of a fat pad had a wide and linear pedicle on the inferior mammary line, and was backed by myofascia (break-line in schema) of the anterior serratus muscle, and occasionally the external oblique muscle .d.We kept as many perforating branches from the muscle