Abstract:

Objective     To summarize the clinical experience of breast reconstruction with soft tissue expander and delayed implant?based reconstruction. Methods Between February 2011 and April 2016，41 patients with breast cancer underwent soft?tissue expander and delayed implant?based reconstruction. The age ranged from 28 to 58 years（median，42 years）. Thirty?eight cases revealed invasive ductal carcinoma and 3 cases invasive ductal carcinoma+DCIS. The median diameter was 2.4 cm，ranging from 1.0 to 4.5 cm. Twenty?four cases were rated as stage Ⅰ ，nine cases as stage ⅡA，seven cases as stage ⅡB，and one case as stage ⅢA. Thirty?two cases underwent modified radical mastectomy and nine cases underwent nipple?sparing mastectomy ，and followed by immediate soft?tissue expander implanta? tion. All the patients received adjuvant therapy according to the NCCN guideline. Delayed implant reconstruction was performed on completing the radiotherapy. Results Thirty?eight cases were successfully reconstructed. There were ten cases of complications out of 41 cases，including five cases of infection ， one case of local skin necrosis ，one case of incision dehiscence ，one case ischemia of skin flap and two cases ischemia of nipple?areola complex. At six months after reconstruction ，the aesthetic Results were excellent in 19 cases，good in 15 cases，fair in two cases and poor in one case. All the cases were follow ?up for 6~56 months（median ，26 months），and three cases of metastasis were found and there is no local recurrence. Conclusion Soft?tissue expander implantation with delayed implant reconstruction can effectively improve the cosmetic effect for patients with breast cancer，without increasing the risk of metastasis and complications.

Key words: breast cancer, expander, implant, breast reconstruction

摘要：

目的 总结软组织扩张器在乳腺癌假体乳房重建术中应用的临床经验。方法 回顾分析我科2011年2月~2016年4月41例乳房切除术后采用软组织扩张器置入联合Ⅱ期假体置入的乳腺癌患者，年龄28~58岁，中位年龄42岁。病理类型：浸润性导管癌38例，导管原位癌伴浸润性导管癌3例。肿瘤直径1.0~4.5cm，中位直径2.4cm。Ⅰ期24例，ⅡA期9例，ⅡB期7例，ⅢA期1例。32例行传统改良根治术，9例行保留乳头乳晕复合体（NAC）的改良根治术。乳房切除术后即刻行软组织扩张器置入，按NCCN指南进行术后辅助治疗，待放疗结束后行II期假体乳房重建术。术后定期随访。结果 成功重建38例。41例术后出现10例并发症，其中5例感染，1例皮肤破损，1例伤口裂开，1例皮瓣缺血，2例乳头乳晕复合体缺血。术后6个月评价美容效果，优19例，良15例，一般2例，差1例，优良率为92%。随访6~56个月，中位随访26个月，出现3例远处转移，无局部复发。结论 乳腺癌患者乳房切除术后软组织扩张器置入加Ⅱ期假体乳房重建可获得良好的美容效果，而不增加复发风险，同时并发症较少。

关键词: 乳房重建, 假体 , 扩张器, 乳腺癌