Abstract：
OBJECTIVE: We propose a pedicled perforator flap technique for salvage nipple reconstruction after initial nipple reconstruction fails in breast cancer patients.
METHODS: This is a pilot study. A total of 21 female breast cancer patients who underwent nipple reconstruction following initial nipple reconstruction fails were enrolled, and salvage nipple reconstruction based pedicled perforator flap were performed between 2016 and 2020. Operative time, perforator design, postoperative complications, follow-up duration, projection of nipple, as well as patient-reported outcomes measured by the BREAST-Q and visual analogue scale (VAS) were assessed.
RESULTS: Sixteen patients underwent fifth lateral intercostal artery perforator reconstruction, while 5 patients underwent fifth anterior intercostal artery perforator flap reconstruction. The surgeries were successful without intraoperative complications, with a mean operative time of 67 minutes. Postoperative complications were absent. The mean follow-up duration was 18 months. The mean nipple projection was 8 mm (range, 6-10 mm) with a shrinkage of 20% at 6 months after surgery. The average scores for psychosocial well-being, satisfaction with breasts, and satisfaction with nipples domains of the BREAST-Q significantly increased (P < .01) at 6 months post-reconstruction. Sexual well-being subdomain showed no statistical difference (P = .9369). The VAS scores for cosmesis and patient satisfaction with surgery were 9 and 9.3, respectively.
CONCLUSIONS: The pedicled perforator flap technique for salvage nipple reconstruction is a safe and effective approach.
METHODS: This is a pilot study. A total of 21 female breast cancer patients who underwent nipple reconstruction following initial nipple reconstruction fails were enrolled, and salvage nipple reconstruction based pedicled perforator flap were performed between 2016 and 2020. Operative time, perforator design, postoperative complications, follow-up duration, projection of nipple, as well as patient-reported outcomes measured by the BREAST-Q and visual analogue scale (VAS) were assessed.
RESULTS: Sixteen patients underwent fifth lateral intercostal artery perforator reconstruction, while 5 patients underwent fifth anterior intercostal artery perforator flap reconstruction. The surgeries were successful without intraoperative complications, with a mean operative time of 67 minutes. Postoperative complications were absent. The mean follow-up duration was 18 months. The mean nipple projection was 8 mm (range, 6-10 mm) with a shrinkage of 20% at 6 months after surgery. The average scores for psychosocial well-being, satisfaction with breasts, and satisfaction with nipples domains of the BREAST-Q significantly increased (P < .01) at 6 months post-reconstruction. Sexual well-being subdomain showed no statistical difference (P = .9369). The VAS scores for cosmesis and patient satisfaction with surgery were 9 and 9.3, respectively.
CONCLUSIONS: The pedicled perforator flap technique for salvage nipple reconstruction is a safe and effective approach.
摘要：
目的：我们提出了一种带蒂穿支皮瓣技术，用于乳腺癌患者乳头重建失败后的乳头重建。
方法：这是一项初步研究。共纳入21例初次乳头重建失败后接受乳头重建的女性乳腺癌患者，在2016年至2020年之间进行了基于带蒂穿支皮瓣的挽救性乳头重建。手术时间,射孔器设计,术后并发症,随访持续时间,乳头突起,以及通过BREAST-Q和视觉模拟评分(VAS)测量的患者报告结局进行评估.
结果：16例患者行第五肋间外侧动脉穿支重建术，5例患者行第五肋间前动脉穿支皮瓣重建。手术成功，没有术中并发症，平均手术时间为67分钟.术后无并发症。平均随访时间为18个月。平均乳头投影为8mm(范围，6-10毫米），术后6个月时收缩率为20％。社会心理幸福感的平均分数，对乳房的满意度，重建后6个月，对BREAST-Q乳头区域的满意度显着增加（P<0.01）。性幸福感亚域无统计学差异(P=.9369)。美容的VAS评分和患者对手术的满意度分别为9和9.3。
结论：带蒂穿支皮瓣修复乳头是一种安全有效的方法。
方法：这是一项初步研究。共纳入21例初次乳头重建失败后接受乳头重建的女性乳腺癌患者，在2016年至2020年之间进行了基于带蒂穿支皮瓣的挽救性乳头重建。手术时间,射孔器设计,术后并发症,随访持续时间,乳头突起,以及通过BREAST-Q和视觉模拟评分(VAS)测量的患者报告结局进行评估.
结果：16例患者行第五肋间外侧动脉穿支重建术，5例患者行第五肋间前动脉穿支皮瓣重建。手术成功，没有术中并发症，平均手术时间为67分钟.术后无并发症。平均随访时间为18个月。平均乳头投影为8mm(范围，6-10毫米），术后6个月时收缩率为20％。社会心理幸福感的平均分数，对乳房的满意度，重建后6个月，对BREAST-Q乳头区域的满意度显着增加（P<0.01）。性幸福感亚域无统计学差异(P=.9369)。美容的VAS评分和患者对手术的满意度分别为9和9.3。
结论：带蒂穿支皮瓣修复乳头是一种安全有效的方法。
