Immediate breast reconstruction with deep inferior epigastric artery perforator flap following nipple-areola-sparing modified radical mastectomy in 14 patients with breast cancer
10.3760/cma.j.cn441206-20240505-00114
- VernacularTitle:保留乳头及乳晕的乳腺癌改良根治术后即刻腹壁下动脉穿支皮瓣重建乳房14例
- Author:
Shun'e XIAO
1
;
Hai LI
;
Xiangkui WU
;
Bihua WU
;
Taolang LI
;
Hongyuan ZHAO
;
Zairong WEI
;
Chengliang DENG
Author Information
1. 遵义医科大学附属医院烧伤整形外科，贵州 遵义 563099
- Keywords:
Breast reconstruction;
Deep inferior epigastric artery perforator flap;
Modified radical mastectomy;
Vascular anastomosis
- From:
Chinese Journal of Microsurgery
2024;47(5):514-519
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the effect of immediate breast reconstruction with a deep inferior epigastric artery perforator flap (DIEPF) after the modified radical mastectomy with nipple and areola preservation for breast cancer.Methods:Clinical data from November 2021 to March 2023 of 14 patients with ages from 29 to 49 (mean 40) years old were retrospectively analysed. All the patients received nipple-areola complex-preserving modified radical mastectomy for breast cancer followed by breast reconstruction with DIEPF at the Department of Burn and Plastic Surgery of the Affiliated Hospital of Zunyi Medical University. Three patients had left breast cancer and 11 had right breast cancer. Preoperative CTA was used to clarify the course and branching of the deep inferior epigastric artery (DIEA) and identify dominant perforators. Intraoperatively, indocyanine green (ICG) angiography was conducted to assess the perfusion of the flap and patency of the vascular anastomoses. Reconstructive surgery were performed using unilateral DIEPF in 4 patients and bilateral DIEPF with internal pressurization in 10 patients. Seven patients underwent anastomosis with intrathoracic vessels as recipient vessels, and 7 with thoracodorsal vessels. The weight of the resected breast tissue was 325.8 g±17.1 g, and the weight of the reconstructed breast flap was 332.9 g±32.1 g. The size of the harvested DIEPF ranged from 16.0 cm×9.0 cm to 24.0 cm×12.0 cm, with the length of the vascular pedicle anastomosed to the recipient vessels at 11.4 cm±1.5 cm. The donor sites were closed by layers with tension-reducing sutures, and the position of the umbilicus was relocated and sutured. All patients were included in the scheduled postoperative follow-up at the outpatient clinic after discharge.Results:Of all 14 patients, no postoperative crisis compromise of flap occurred, and both the recipient and donor sites healed primarily. During a follow-up period of 6 to 16 months, with an average of 11 months, no breast cancer recurrence was observed, and the aesthetic outcomes of the reconstructed breast were satisfactory without obvious complications.Conclusion:Breast reconstruction with DIEPF immediately after modified radical mastectomy with sparing nipple and areola can achieve good aesthetic results, less complications in the donor site and with high patient satisfaction rate.
