皮瓣重建乳房手术

概述

乳房再造是一种在乳房切除术——切除乳房以治疗或预防乳腺癌的手术——后恢复乳房形状的手术。皮瓣重建乳房手术涉及从身体的一个区域——通常是腹部——取出一部分组织，并将其移植到新的地方，以此来造出一个新的乳房。

皮瓣重建乳房手术是一项由整形外科医生进行的复杂手术。使用乳房自身组织进行的大部分乳房再造可在乳房切除术时完成（立即再造），尽管有时可在以后的单独手术中完成（延迟再造）。

整形外科医生可能会建议分两个步骤进行手术。第一阶段是植入扩张器，第二阶段是完成组织再造。患者可能需要接受其它手术来进行乳头再造。

目的

Breast reconstruction with flap surgery is done to restore shape to a breast after a mastectomy. Many people choose breast reconstruction after mastectomy to feel better about themselves and how they look.

There are two main kinds of breast reconstruction. One uses tissue flaps and the other uses breast implants. The ways of doing breast reconstruction surgery each have advantages and disadvantages. A plastic surgeon can talk about these with you.

In general, a breast reconstructed using a tissue flap may look and feel more natural than a breast reconstructed with an implant. Once the reconstruction is completed with a tissue flap, you typically don't need more surgery in the future. With a breast implant, you may need more surgery in the future to replace or remove the implant. Using a tissue flap for breast reconstruction is a more complex operation. It typically requires a longer hospital stay and it often has a longer recovery compared to using a breast implant.

A plastic surgeon can talk with you about your options. The surgeon can help you choose which type of reconstruction is better for you.

风险

皮瓣移植乳房再造术有并发症风险。并发症可能与手术或组织皮瓣有关。

Risks of surgery

The risks of breast reconstruction surgery include:

• Slow healing of cuts in the skin, called incisions.
• Infection.
• Bleeding.
• Risks linked to the medicine that puts you in a sleeplike state during surgery. The medicine is called a general anesthetic. Risks include nausea, vomiting and confusion.

Risks of having flap surgery

The risks of having breast reconstruction with tissue flaps include:

• Tissue death, called necrosis, from too little blood supply to the new breast.
• Loss of feeling at the place where the tissue flap is taken from.
• A weakness in the belly wall that may let tissue come through, making a bulge. This is called an abdominal hernia.

Radiation therapy to the skin and chest wall after breast reconstruction with flap surgery may cause complications during healing. Your healthcare team may suggest that you wait until after radiation therapy to have breast reconstruction with flap surgery.

如何进行准备

乳房切除术前，医生可能会建议您去看整形外科医生。咨询经专科认证并且在乳房切除术后乳房再造方面经验丰富的整形外科医生。理想的状态是乳房外科医生和整形外科医生根据您的情况，共同制定最佳的外科治疗和乳房再造策略。

整形外科医生会向您描述手术方案，展示接受不同类型乳房再造术的女性照片。您的体型、健康状况和癌症治疗因素将决定哪种类型的重建对您最有益。整形外科医生还会提供麻醉、手术地点以及可能需要的随访复诊程序等信息。

整形外科医生可能会谈论手术对另一侧乳房的利弊，即使另一侧乳房很健康，也应尽量使再造的乳房与另一侧乳房的形状和大小一致。切除健康乳房的手术（对侧预防性乳房切除术）会使手术并发症的风险增加一倍，如出血和感染风险。另外，手术后对整容效果的满意度可能会降低。

手术前，按照医生的指示准备手术。内容可能包括饮食和饮酒指南、调整现有药物和戒烟。

可能出现的情况

新乳房看起来可能会与您的自然乳房不完全一致。但是，新乳房通常可以恢复乳房的轮廓，以使您的轮廓看起来与手术前的轮廓相似。

皮瓣重建乳房手术是最复杂的乳房重建方案。外科医生将身体某部分的一块皮肤、肌肉、脂肪和血管转移至胸部，以重塑乳房丘。在某些情况下，需要用乳房植入物来增大皮肤和组织，以达到所需的乳房大小。

皮瓣手术的类型

常用于乳房再造的组织皮瓣类型包括：

• 带蒂皮瓣。 带蒂皮瓣手术需要切取组织，但保留多数血管。整形外科医生切断用于乳房再造组织的部分血管，但完整保留其他血管。将组织移植到胸部皮下。然后用该组织构建新的乳房。
• 游离皮瓣。 游离皮瓣手术需要切取组织和血管。整形外科医生将组织与其供血血管分离，然后将该组织与胸部附近的新血管缝合连接。由于需要缝合血管，因此游离皮瓣手术持续时间通常比带蒂皮瓣手术更长。

皮瓣移植乳房再造术使用的组织皮瓣需要有良好血流，才能存活。如果您患有可能导致血流问题的状况，这项手术可能不太适合您。例如糖尿病、血管疾病和结缔组织疾病。如果您抽烟，则需要在手术前戒烟。医疗护理团队可能要求您在手术前戒烟 4 至 6 周。

TRAM flap

During transverse rectus abdominis muscle flap surgery, a plastic surgeon removes tissue with muscle from the belly. This procedure also is called TRAM flap surgery. The TRAM flap can be done as a pedicle flap or a free flap.

A pedicle TRAM flap uses the whole rectus muscle. The rectus muscle is one of the major abdominal muscles.

For a muscle-sparing free TRAM flap, a surgeon takes only a part of the rectus abdominis muscle. This may help you keep abdominal strength after surgery.

DIEP 皮瓣

腹壁下深血管穿支（DIEP）皮瓣手术也使用腹部组织。该手术和 TRAM 皮瓣手术一样，但外科医生只移取腹部皮肤和脂肪用于重建新乳房，而将大部分腹肌保留在原位。这种类型乳房重建术的一个好处是保留了更多的腹肌力量。

外科医生在显微镜下将组织皮瓣与胸部血管缝合连接。

SEIA flap

Superficial inferior epigastric artery flap surgery also is called SIEA flap surgery. The SIEA flap uses the same belly tissue as the DEIP flap. But it uses blood vessels that aren't as deep within the belly. This is a less invasive surgery. But not everyone has SIEA blood vessels that will work for this type of flap surgery.

TUG flap

Transverse upper gracilis flap surgery, also called TUG flap surgery, uses muscle and fatty tissue from the bottom of the buttocks to the inner thigh.

PAP Flap

Profunda artery perforator flap surgery, also called PAP flap surgery, uses skin and fat from the back of the upper thigh. The benefit of this flap compared to the TUG flap is the surgeon takes no muscle.

Latissimus dorsi flap

Latissimus dorsi flap surgery takes skin, fat and muscle from the back. The surgeon transfers it under the skin to the chest. This kind of flap surgery typically takes less skin and fat than other kinds of flaps, so this approach most often uses a breast implant with the flap.

Gluteal flap

A gluteal flap surgery is a free flap procedure that takes tissue from the buttocks and transplants it to the chest area. A gluteal flap may be for people who want tissue reconstruction but who don't have enough extra tissue in their backs or bellies.

After the procedure

After surgery, you may wear a stretchy bandage or support bra to keep swelling down and support the reconstructed breast. You may have a small tube under your skin for a time to drain blood or fluids. Your healthcare professional prescribes medicine to help manage your pain.

You may be tired and sore for several weeks after surgery. Getting back to usual activities takes time. Take it easy during this period.

You might need to restrict your activities. Follow your healthcare team's instructions on what activities are not OK. This may include not doing any overhead lifting or anything that could cause strain.

Contact your plastic surgeon right away if you have worries about your reconstruction.

乳头再造

如果您愿意，乳房再造也可能涉及乳头的再造。再造新乳头的手术称为乳头重建。整形外科医生通常会在皮瓣手术康复后进行乳头重建。当乳头愈合后，您可以选择在乳头及其周围皮肤环形区（即乳晕）上纹身为其上色。

后期乳腺癌筛查

如果您只重建了一侧乳房，需要继续通过乳腺 X 线摄影对另一侧乳房进行乳腺癌筛查。通常无需对重建的乳房进行乳腺 X 线摄影。

继续对两侧乳房（包括重建的乳房）进行自检。如有发现任何变化，请告知医疗护理专业人员。

结果

假体置入乳房再造术的效果如何可能不会立刻显现。胸部的组织需要一定时间才能愈合。愈合之后，您很可能会与手术团队见面以谈论效果。

乳房再造的目的是在乳房手术后最大程度地恢复最自然的乳房外观和触感。但是，乳房再造无法实现与癌前同样的乳房外观或触感。务必要实事求是地看待乳房重建的预期效果。

乳房再造能够做到：

• 恢复乳房形态。
• 穿衣服或泳衣时让双侧乳房看起来更加一样。
• 可以不用在胸罩内使用假体，即一个乳房形状的外用填充物。

乳房再造或许能够做到：

• 改善您对自己和自己身体的感觉。
• 消除癌症留在身体上的一些痕迹。

乳房再造无法做到：

• 让您看起来和乳房切除术前一样。
• 让重建乳房获得与手术前一样的触感。

临床试验

探索 Mayo Clinic 的研究 测试新的治疗、干预与检查方法，旨在预防、检测、治疗或控制这种疾病。

在妙佑医疗国际的体验与患者故事

患者告诉我们，互动质量、关注细节以及就医效率都是他们从未经历过的医疗体验。查看妙佑医疗国际满意患者的故事。