脂肪筋膜瓣乳房整形课件

Adipofascialflap天津市肿瘤医院乳腺一科陈祖锦11Adipofascialflap天津市肿瘤医院乳腺一科11I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I级Ⅱ级乳腺组织切除量少于20%乳腺组织切除量在20~50VolumeDisplacement用残存乳腺组织进行美学重塑保乳术后乳房整形VolumeReplacement用非乳腺织进行替代填充VolumeDisplacement保乳术后乳房整形VolVolumereplacementtechniques

AdipofascialflapLateralthoracodorsalflapThoracoepigastricflapIntercostalarteryperforator(ICAP)flapThoracodorsalarteryperforator(TDAP)flapLatissimusdorsi(LD)myocutaneousflapVolumereplacementtechniquesProcedureforharvestingtheC-shapedthoracodorsalflapandrepairofthedefect.(A)Bythesameskinincisionuponthemiddleaxillaryline,wecandothepartialresectionofthebreast,axillarylymphnodedissection,andgettheadipofascialflap.(B)AC-shapedthoracodorsaladipofascialflapwasharvestedafterlocalresectionofthebreastandaxillarylymphnodedissection.(C)Attachingthefasciaofthelatissimusdorsimuscletotheadiposetissuemakestheharvestedtissuefirm.(D)Theflapisrotatedtothemedialsidetofillthedefect.Wesometimesrollorgatherittoreconstructtothebreastmound.ThoracodorsaladipofascialflapProcedureforharvestingtheC42-year-oldladywithbreastcancerlocatedonupperouter-quadrantoftherightbreast(Case1)(A)Aresectedareaofthebreastwiththegrossmarginas3cmandaC-shapedthoracodorsaladipofascialflapwasmarkedbeforesurgery.(BandC)6monthspost-surgery.Thedeformityofbothbreastanddonorsiteisinconspicuous.42-year-oldladywithbreast6-year-oldladywithbreastcancerlocatedonupperouter-quadrantoftherightbreast(Case2).(A)Aresectedareaofthebreastwiththegrossmarginas3cmandaC-shapedthoracodorsaladipofascialflapwasmarkedbeforesurgery.(BandC)6monthspost-surgery.Thecosmeticresultwasexcellent.6-year-oldladywithbreastcaModifiedthoracodorsaladipofascialcutaneousflapModifiedthoracodorsaladipofas脂肪筋膜瓣乳房整形课件脂肪筋膜瓣乳房整形课件.A27-year-oldwomanwithbreastcancerlocatedintheupper-outerquadrantoftherightbreast(Case2).(A)Amodifiedthoracodorsaladipofascialcutaneousflapwasdesignedsothatitcouldbeharvestedviaanincisionalongtheanterioraxillarylineandanadditionalbackincision.(B)(C)Sixmonthspostsurgery.Thebilateralincisionswereinconspicuousfromtheanteriorview.A27-year-oldwomanwithbrea脂肪筋膜瓣乳房整形课件脂肪筋膜瓣乳房整形课件Thelocalfindings1yearafterthesurgeryThelocalfindings1yearafterFreedermalfatgraft(FDFG)A57-year-oldpatientwithaslimbodyandnon-ptoticbreasts(case2)(A)Preoperativefindings;(B)Anincisionlinewasdrawninredacrossthenipple.Afreedermalfatgraft(FDFG)fromthelowerabdomenwasimplantedinthecylinder-shapeddeformityinthecentralbreast;(C)Fouryearsaftersurgery.Freedermalfatgraft(FDFG)AA58-year-oldpatientwithPaget’sdiseaseintherightbreast(case3).(A)Preoperativefindings;(B)Anincisionlinewasdrawninred.Thenipple,butnottheareolawasremovedtogetherwiththebreasttissue.Afreedermalfatgraft(FDFG)fromthelowerabdomenwasharvestedforimplantationintothebreastdefect(15,16);(C)Sevenyearsaftersurgery.A58-year-oldpatientwithPag(a)Insitude-epithelializationoftheentireskinpaddlewasperformed.(b)Anellipseoffatanddermiswasremovedbysharpdissection.(c)TheFDFGwasturnedoversothatthedermisfacedthesurfaceofthepectoralismajorandwasfixedsecurelyalongtheentireperiphery.Figure5UltrasonographyrevealedgoodFDFGvolumeoneyearaftertheoperation(F:FDFG,G:normalgland).(a)Insitude-epithelializatCase1:preoperativemarkingsoftheareatoberesectedina53-year-oldpatientwithaT1tumorinthelower-outerquadrantoftheleftbreast.aApurplespotformedaftercoreneedlebiopsy(CNB).Herbreastswerenotptotic.b,cThecancerlesionandthescarinthe6o’clockpositionleftbytheCNBarecircledinred.TheincisionlineisdrawninredalongtheinframammarylineInframammaryadipofascialflapCase1:preoperativemarkingsOperativefindings.aAtongue-shapedadipofascialflap,10cminlength,wasdrawnasablackdottedline.Acrescentofskinwasde-epithelialized.bTheflapwasharvestedviaaninframammaryincisionlineandacaudalwindow.cThede-epithelializedskinwasharvestedtogetherwiththeinframammaryflap.dThetissuewasrolleduptowardsthecranialsideOperativefindings.脂肪筋膜瓣乳房整形课件a,binferioradipofascialtissuerepairSkinincisionwasplacedoninfra-mammaryline.c.Thisflapofafatpadhadawideandlinearpedicleontheinferiormammaryline,andwasbackedbymyofascia(break-lineinschema)oftheanteriorserratusmuscle,andoccasionallytheexternalobliquemuscle.d.Wekeptasmanyperforatingbranchesfromthemusclebodyaspossible.Asshowninschema,weconvertedthisflap

intodeadspace,suturedthefasciatothestumpofresidualbreasttissue,andsetuptorefillthedefectofthemoun

a,binferioradipofascialtissadiposetissuefromthesubclaviculararea

adiposetissuefromthesubclaThankyouThankyouAdipofascialflap天津市肿瘤医院乳腺一科陈祖锦11Adipofascialflap天津市肿瘤医院乳腺一科11I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I级Ⅱ级乳腺组织切除量少于20%乳腺组织切除量在20~50VolumeDisplacement用残存乳腺组织进行美学重塑保乳术后乳房整形VolumeReplacement用非乳腺织进行替代填充VolumeDisplacement保乳术后乳房整形VolVolumereplacementtechniques

AdipofascialflapLateralthoracodorsalflapThoracoepigastricflapIntercostalarteryperforator(ICAP)flapThoracodorsalarteryperforator(TDAP)flapLatissimusdorsi(LD)myocutaneousflapVolumereplacementtechniquesProcedureforharvestingtheC-shapedthoracodorsalflapandrepairofthedefect.(A)Bythesameskinincisionuponthemiddleaxillaryline,wecandothepartialresectionofthebreast,axillarylymphnodedissection,andgettheadipofascialflap.(B)AC-shapedthoracodorsaladipofascialflapwasharvestedafterlocalresectionofthebreastandaxillarylymphnodedissection.(C)Attachingthefasciaofthelatissimusdorsimuscletotheadiposetissuemakestheharvestedtissuefirm.(D)Theflapisrotatedtothemedialsidetofillthedefect.Wesometimesrollorgatherittoreconstructtothebreastmound.ThoracodorsaladipofascialflapProcedureforharvestingtheC42-year-oldladywithbreastcancerlocatedonupperouter-quadrantoftherightbreast(Case1)(A)Aresectedareaofthebreastwiththegrossmarginas3cmandaC-shapedthoracodorsaladipofascialflapwasmarkedbeforesurgery.(BandC)6monthspost-surgery.Thedeformityofbothbreastanddonorsiteisinconspicuous.42-year-oldladywithbreast6-year-oldladywithbreastcancerlocatedonupperouter-quadrantoftherightbreast(Case2).(A)Aresectedareaofthebreastwiththegrossmarginas3cmandaC-shapedthoracodorsaladipofascialflapwasmarkedbeforesurgery.(BandC)6monthspost-surgery.Thecosmeticresultwasexcellent.6-year-oldladywithbreastcaModifiedthoracodorsaladipofascialcutaneousflapModifiedthoracodorsaladipofas脂肪筋膜瓣乳房整形课件脂肪筋膜瓣乳房整形课件.A27-year-oldwomanwithbreastcancerlocatedintheupper-outerquadrantoftherightbreast(Case2).(A)Amodifiedthoracodorsaladipofascialcutaneousflapwasdesignedsothatitcouldbeharvestedviaanincisionalongtheanterioraxillarylineandanadditionalbackincision.(B)(C)Sixmonthspostsurgery.Thebilateralincisionswereinconspicuousfromtheanteriorview.A27-year-oldwomanwithbrea脂肪筋膜瓣乳房整形课件脂肪筋膜瓣乳房整形课件Thelocalfindings1yearafterthesurgeryThelocalfindings1yearafterFreedermalfatgraft(FDFG)A57-year-oldpatientwithaslimbodyandnon-ptoticbreasts(case2)(A)Preoperativefindings;(B)Anincisionlinewasdrawninredacrossthenipple.Afreedermalfatgraft(FDFG)fromthelowerabdomenwasimplantedinthecylinder-shapeddeformityinthecentralbreast;(C)Fouryearsaftersurgery.Freedermalfatgraft(FDFG)AA58-year-oldpatientwithPaget’sdiseaseintherightbreast(case3).(A)Preoperativefindings;(B)Anincisionlinewasdrawninred.Thenipple,butnottheareolawasremovedtogetherwiththebreasttissue.Afreedermalfatgraft(FDFG)fromthelowerabdomenwasharvestedforimplantationintothebreastdefect(15,16);(C)Sevenyearsaftersurgery.A58-year-oldpatientwithPag(a)Insitude-epithelializationoftheentireskinpaddlewasperformed.(b)Anellipseoffatanddermiswasremovedbysharpdissection.(c)TheFDFGwasturnedoversothatthedermisfacedthesurfaceofthepectoralismajorandwasfixedsecurelyalongtheentireperiphery.Figure5UltrasonographyrevealedgoodFDFGvolumeoneyearaftertheoperation(F:FDFG,G:normalgland).(a)Insitude-epithelializatCase1:preoperativemarkingsoftheareatoberesectedina53-year-oldpatientwithaT1tumorinthelower-outerquadrantoftheleftbreast.aApurplespotformedaftercoreneedlebiopsy(CNB).Herbreastswerenotptotic.b,cThecancerlesionandthescarinthe6o’clockpositionleftbytheCNBarecircledinred.TheincisionlineisdrawninredalongtheinframammarylineInframammaryadipofascialflapCase1:preoperativemarking