1、Add Your Company SloganAdipofascial flap天津市天津市肿肿瘤瘤医医院乳腺一科院乳腺一科陈陈祖祖锦锦1111I 级级级级乳腺组织切除量少于乳腺组织切除量少于20%20%不需要切除多余皮不需要切除多余皮直接缝合无需乳房成直接缝合无需乳房成形术形术适用于腺体致密的乳适用于腺体致密的乳房房不需要整形技术训练不需要整形技术训练乳腺组织切除量在乳腺组织切除量在2050%2050%之间之间需要切除多余皮肤需要切除多余皮肤基于乳房成形术基于乳房成形术腺体致密或脂肪含量丰腺体致密或脂肪含量丰富的乳房均适用富的乳房均适用需要一定的专业整形技需要一定的专业整形技术训练术训练基于
2、乳腺切除的量及手术相对难度将基于乳腺切除的量及手术相对难度将OPSOPS分为两级分为两级Volume Displacement用残存乳腺组织用残存乳腺组织进行美学重塑进行美学重塑保乳术后乳房整形保乳术后乳房整形Volume Replacement用非乳腺织进行用非乳腺织进行替代填充替代填充Volume replacement techniques Adipofascial flap Lateral thoracodorsal flapThoracoepigastric flap Intercostal artery perforator(ICAP)flap Thoracodorsal arte
3、ry perforator(TDAP)flap Latissimus dorsi(LD)myocutaneous flapProcedure for harvesting the C-shaped thoracodorsal flap and repair of the defect.(A)By the same skin incision upon the middle axillary line,we can do the partial resection of the breast,axillary lymph node dissection,and get the adipofasc
4、ial flap.(B)A C-shaped thoracodorsal adipofascial flap was harvested after local resection of the breast and axillary lymph node dissection.(C)Attaching the fascia of the latissimus dorsi muscle to the adipose tissue makes the harvested tissue firm.(D)The flap is rotated to the medial sideto fill th
5、e defect.We sometimes roll or gather it to reconstruct to the breast mound.Thoracodorsal adipofascial flap 42-year-old lady with breast cancer located on upper outer-quadrant of the right breast(Case 1)(A)A resected area of the breast with the gross margin as 3 cm and a C-shaped thoracodorsal adipof
6、ascial flap 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 the right breast(Case 2).(A)A resected area of the breast with the gross margin as 3 cm and a C-shap
7、ed thoracodorsal adipofascial flap was marked before surgery.(B and C)6 months post-surgery.The cosmetic result was excellent.Modified thoracodorsal adipofascial cutaneous flap.A 27-year-old woman with breast cancer located in the upper-outer quadrant of the right breast(Case 2).(A)A modified thorac
8、odorsal adipofascial cutaneous flap 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 bilateral incisions were inconspicuous from the anterior viewThe local findings 1 year after the surgery Fr
9、ee 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 graft(FDFG)from the lower abdomen was implanted in the cylinder-shaped deformity in the central breast;(C)Fo
10、ur 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 was removed together with the breast tissue.A free dermal fat graft(FDFG)from the lower abdomen was harvested for i
11、mplantation 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 was removed by sharp dissection.(c)The FDFG was turned over so that the dermis faced the surface of the pectoralis major and
12、was fixed 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 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 purp
13、le 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 red.The incision line is drawn in red along the inframammary lineInframammary adipofascial flapOperative findings.a A tongue-shaped adip
14、ofascial flap,10 cm in length,was drawn as a black dotted line.A crescent of skin was de-epithelialized.b The flap was harvested via an inframammary incision line and a caudal window.c The de-epithelialized skin was harvested together with the inframammary flap.d The tissue was rolled up towards the
15、 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 obliq
16、ue muscle.d.We kept as many perforating branches from the muscle body as possible.As shown in schema,we converted this flapinto dead space,sutured the fascia to the stump of residual breast tissue,and set up to refill the defect of the mounadipose tissue from the subclavicular area Add Your Company SloganThank you
