AddYourCompanySloganAdipofascialflap天津市肿瘤医院乳腺一科陈祖锦11I级I级Ⅱ级Ⅱ级乳腺组织切除量少于20%不需要切除多余皮直接缝合无需乳房成形术适用于腺体致密的乳房不需要整形技术训练乳腺组织切除量少于20%不需要切除多余皮直接缝合无需乳房成形术适用于腺体致密的乳房不需要整形技术训练乳腺组织切除量在20~50%之间需要切除多余皮肤基于乳房成形术腺体致密或脂肪含量丰富的乳房均适用需要一定的专业整形技术训练乳腺组织切除量在20~50%之间需要切除多余皮肤基于乳房成形术腺体致密或脂肪含量丰富的乳房均适用需要一定的专业整形技术训练基于乳腺切除的量及手术相对难度将OPS分为两级基于乳腺切除的量及手术相对难度将OPS分为两级VolumeDisplacement用残存乳腺组织进行美学重塑保乳术后乳房整形保乳术后乳房整形VolumeReplacement用非乳腺织进行替代填充VolumeReplacement用非乳腺织进行替代填充Volumereplacementtechniques•Adipofascialflap•Lateralthoracodorsalflap•Thoracoepigastricflap•Intercostalarteryperforator(ICAP)flap•Thoracodorsalarteryperforator(TDAP)flap•Latissimusdorsi(LD)myocutaneousflapProcedureforharvestingtheC-shapedthoracodorsalflapandrepairofthedefect.(A)Bythesameskinincisionuponthemiddleaxillaryline,wecandothepartialresectionofthebreast,axillarylymphnodedissection,andgettheadipofascialflap.(B)AC-shapedthoracodorsaladipofascialflapwasharvestedafterlocalresectionofthebreastandaxillarylymphnodedissection.(C)Attachingthefasciaofthelatissimusdorsimuscletotheadiposetissuemakestheharvestedtissuefirm.(D)Theflapisrotatedtothemedialsidetofillthedefect.Wesometimesrollorgatherittoreconstructtothebreastmound.Thoracodorsaladipofascialflap42-year-oldladywithbreastcancerlocatedonupperouter-quadrantoftherightbreast(Case1)(A)Aresectedareaofthebreastwiththegrossmarginas3cmandaC-shapedthoracodorsaladipofascialflapwasmarkedbeforesurgery.(BandC)6monthspost-surgery.Thedeformityofbothbreastanddonorsiteisinconspicuous.6-year-oldladywithbreastcancerlocatedonupperouter-quadrantoftherightbreast(Case2).(A)Aresectedareaofthebreastwiththegrossmarginas3cmandaC-shapedthoracodorsaladipofascialflapwasmarkedbeforesurgery.(BandC)6monthspost-surgery.Thecosmeticresultwasexcellent.Modifiedthoracodorsaladipofascialcutaneousflap.A27-year-oldwomanwithbreastcancerlocatedintheupper-outerquadrantoftherightbreast(Case2).(A)Amodifiedthoracodorsaladipofascialcutaneousflapwasdesignedsothatitcouldbeharvestedviaanincisionalongtheanterioraxillarylineandanadditionalbackincision.(B)(C)Sixmonthspostsurgery.ThebilateralincisionswereinconspicuousfromtheanteriorviewThelocalfindings1yearafterthesurgeryFreedermalfatgraft(FDFG)A57-year-oldpatientwithaslimbodyandnon-ptoticbreasts(case2)(A)Preoperativefindings;(B)Anincisionlinewasdrawninredacrossthenipple.Afreedermalfatgraft(FDFG)fromthelowerabdomenwasimplantedinthecylinder-shapeddeformityinthecentralbreast;(C)Fouryearsaftersurgery.A58-year-oldpatientwithPaget’sdiseaseintherightbreast(case3).(A)Preoperativefindings;(B)Anincisionlinewasdrawninred.Thenipple,butnottheareolawasremovedtogetherwiththebreasttissue.Afreedermalfatgraft(FDFG)fromthelowerabdomenwasharvestedforimplantationintothebreastdefect(15,16);(C)Sevenyearsaftersurgery.(a)Insitude-epithelializationoftheentireskinpaddlewasperformed.(b)Anellipseoffatanddermiswasremovedbysharpdissection.(c)TheFDFGwasturnedoversothatthedermisfacedthesurfaceofthepectoralismajorandwasfixedsecurelyalongtheentireperiphery.Figure5UltrasonographyrevealedgoodFDFGvolumeoneyearaftertheoperation(F:FDFG,G:normalgland).Case1:preoperativemarkingsoftheareatoberesectedina53-year-oldpatientwithaT1tumorinthelower-outerquadrantoftheleftbreast.aApurplespotformedaftercoreneedlebiopsy(CNB).Herbreastswerenotptotic.b,cThecancerlesionandthescarinthe6o’clockpositionleftbytheCNBarecircledinred.TheincisionlineisdrawninredalongtheinframammarylineInframammaryadipofascialflapOperativefindings.aAtongue-shapedadipofascialflap,10cminlength,wasdrawnasablackdottedline.Acrescentofskinwasde-epithelialized.bTheflapwasharvestedviaaninframammaryincisionlineandacaudalwindow.cThede-epithelializedskinwasharvestedtogetherwiththeinframammaryflap.dThetissuewasrolleduptowardsthecranialsidea,binferioradipofascialtissuerepairSkinincisionwasplacedoninfra-mammaryline.c.Thisflapofafatpadhadawideandlinearpedicleontheinferiormammaryline,andwasbackedbymyofascia(break-lineinschema)oftheanteriorserratusmuscle,andoccasionallytheexternalobliquemuscle.d.Wekeptasmanyperforatingbranchesfromthemusclebodyaspossible.Asshowninschema,weconvertedthisflapintodeadspace,suturedthefasciatothestumpofresidualbreasttissue,andsetuptorefillthedefectofthemounadiposetissuefromthesubclavicularareaAddYourCompanySloganThankyou
