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Abstract：
OBJECTIVE: To investigate the choice of immediate breast reconstructive methods and asso-ciated outcomes after modified radical mastectomy.
METHODS: Retrospective analysis of patients undergoing immediate breast reconstruction after modified radical mastectomy in Peking University Third Hospital from January 2009 to May 2019. The reconstructive methods were summarized, and the clinical outcomes and the safety of immediate breast reconstruction were evaluated.
RESULTS: One hundred and twenty-three patients were enrolled in this study. Different reconstructive methods were applied according to the clinical stage, the amount of skin removal, the size of contralateral breasts, the physical condition and the preference of the patients. Seventy-nine cases were performed with tissue expander/implant two-stage reconstruction, twenty-three cases received direct breast implant insertion, seven cases were applied for latissimus dorsi (LD) myocutaneous flap transfer combined with implant insertion, five cases were provided transverse rectus abdominis myocutaneous (TRAM) flap transfer, six cases underwent tissue expander/implant combined with endoscopic LD muscle flap transfer, and three cases chose tissue expander/deep inferior epigastric artery perforator (DIEP) flap transfer. The average follow-up time was (12.3±9.0) months (3.5-41.0 months). One patient with direct implant insertion had partial blood supply distur-bance of the mastectomy flap. One case had necrosis of distal end of TRAM zone Ⅳ. One patient with expander/DIEP reconstruction had partial fat liquefaction. And two cases had expander leakage at the end of the expansion period. The tumor local recurrence occurred in one patient, and the implant was finally removed. The outcomes were evaluated by Harris method, and 90.2% patients were good or above in shape evaluation. Among the patients with implant based reconstruction, there was no obvious capsular contracture, and most of the implants had good or fair mobility.
CONCLUSIONS: It is safe and feasible of immediate breast reconstruction after modified radical mastectomy for appropriate cases. The reconstructive methods can be individualized according to the individual\'s different conditions. The appropriate reconstructive methods could achieve satisfactory results.
METHODS: Retrospective analysis of patients undergoing immediate breast reconstruction after modified radical mastectomy in Peking University Third Hospital from January 2009 to May 2019. The reconstructive methods were summarized, and the clinical outcomes and the safety of immediate breast reconstruction were evaluated.
RESULTS: One hundred and twenty-three patients were enrolled in this study. Different reconstructive methods were applied according to the clinical stage, the amount of skin removal, the size of contralateral breasts, the physical condition and the preference of the patients. Seventy-nine cases were performed with tissue expander/implant two-stage reconstruction, twenty-three cases received direct breast implant insertion, seven cases were applied for latissimus dorsi (LD) myocutaneous flap transfer combined with implant insertion, five cases were provided transverse rectus abdominis myocutaneous (TRAM) flap transfer, six cases underwent tissue expander/implant combined with endoscopic LD muscle flap transfer, and three cases chose tissue expander/deep inferior epigastric artery perforator (DIEP) flap transfer. The average follow-up time was (12.3±9.0) months (3.5-41.0 months). One patient with direct implant insertion had partial blood supply distur-bance of the mastectomy flap. One case had necrosis of distal end of TRAM zone Ⅳ. One patient with expander/DIEP reconstruction had partial fat liquefaction. And two cases had expander leakage at the end of the expansion period. The tumor local recurrence occurred in one patient, and the implant was finally removed. The outcomes were evaluated by Harris method, and 90.2% patients were good or above in shape evaluation. Among the patients with implant based reconstruction, there was no obvious capsular contracture, and most of the implants had good or fair mobility.
CONCLUSIONS: It is safe and feasible of immediate breast reconstruction after modified radical mastectomy for appropriate cases. The reconstructive methods can be individualized according to the individual\'s different conditions. The appropriate reconstructive methods could achieve satisfactory results.
摘要：
目的：探讨改良根治术后即刻乳房重建方法的选择及预后。
方法：回顾性分析2009年1月至2019年5月在北京大学第三医院行乳腺癌改良根治术后即刻乳房再造的患者。总结了重建方法，并对即刻乳房再造的临床结局和安全性进行了评价.
结果：本研究纳入了123例患者。根据临床分期采用不同的重建方法,去除皮肤的量，对侧乳房的大小，患者的身体状况和偏好。79例患者行组织扩张器/植入物两阶段重建,23例接受直接乳房植入物插入，7例应用背阔肌(LD)肌皮瓣转移联合种植体插入,5例提供腹直肌肌皮瓣转移，6例患者行组织扩张器/植入物联合内镜下LD肌瓣转移术,3例选择组织扩张器/腹壁下动脉穿支（DIEP）皮瓣转移。随访时间3.5～41.0个月,平均(12.3±9.0)个月。一名直接插入植入物的患者的乳房切除术皮瓣部分供血不足。1例TRAMⅣ区远端坏死。一名扩张器/DIEP重建患者部分脂肪液化。有两种情况在膨胀期结束时发生了膨胀泄漏。1例患者出现肿瘤局部复发，植入物最终被移除。采用Harris方法评价结果，90.2%的患者形状评价良好或以上。在植入重建的患者中，没有明显的包膜挛缩,大多数植入物具有良好或公平的移动性。
结论：对于适当的病例，行乳腺癌改良根治术后即刻乳房再造是安全可行的。重建方法可以根据个人的不同情况进行个性化。适当的重建方法可以取得满意的结果。
方法：回顾性分析2009年1月至2019年5月在北京大学第三医院行乳腺癌改良根治术后即刻乳房再造的患者。总结了重建方法，并对即刻乳房再造的临床结局和安全性进行了评价.
结果：本研究纳入了123例患者。根据临床分期采用不同的重建方法,去除皮肤的量，对侧乳房的大小，患者的身体状况和偏好。79例患者行组织扩张器/植入物两阶段重建,23例接受直接乳房植入物插入，7例应用背阔肌(LD)肌皮瓣转移联合种植体插入,5例提供腹直肌肌皮瓣转移，6例患者行组织扩张器/植入物联合内镜下LD肌瓣转移术,3例选择组织扩张器/腹壁下动脉穿支（DIEP）皮瓣转移。随访时间3.5～41.0个月,平均(12.3±9.0)个月。一名直接插入植入物的患者的乳房切除术皮瓣部分供血不足。1例TRAMⅣ区远端坏死。一名扩张器/DIEP重建患者部分脂肪液化。有两种情况在膨胀期结束时发生了膨胀泄漏。1例患者出现肿瘤局部复发，植入物最终被移除。采用Harris方法评价结果，90.2%的患者形状评价良好或以上。在植入重建的患者中，没有明显的包膜挛缩,大多数植入物具有良好或公平的移动性。
结论：对于适当的病例，行乳腺癌改良根治术后即刻乳房再造是安全可行的。重建方法可以根据个人的不同情况进行个性化。适当的重建方法可以取得满意的结果。
