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11精品课件I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分为两级精品课件VolumeDisplacement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精品课件Volumereplacementtechniques

AdipofascialflapLateralthoracodorsalflapThoracoepigastricflapIntercostalarteryperforator(ICAP)flapThoracodorsalarteryperforator(TDAP)flapLatissimusdorsi(LD)myocutaneousflap精品课件ProcedureforharvestingtheC-shapedthoracodorsalflapandrepairofthedefect.(A)Bythesameskinincisionuponthemiddleaxillaryline,wecandothepartialresectionofthebreast,axillarylymphnodedissection,andgettheadipofascialflap.(B)AC-shapedthoracodorsaladipofascialflapwasharvestedafterlocalresectionofthebreastandaxillarylymphnodedissection.(C)Attachingthefasciaofthelatissimusdorsimuscletotheadiposetissuemakestheharvestedtissuefirm.(D)Theflapisrotatedtothemedialsidetofillthedefect.Wesometimesrollorgatherittoreconstructtothebreastmound.Thoracodorsaladipofascialflap精品课件42-year-oldladywithbreastcancerlocatedonupperouter-quadrantoftherightbreast(Case1)(A)Aresectedareaofthebreastwiththegrossmarginas3cmandaC-shapedthoracodorsaladipofascialflapwasmarkedbeforesurgery.(BandC)6monthspost-surgery.Thedeformityofbothbreastanddonorsiteisinconspicuous.精品课件6-year-oldladywithbreastcancerlocatedonupperouter-quadrantoftherightbreast(Case2).(A)Aresectedareaofthebreastwiththegrossmarginas3cmandaC-shapedthoracodorsaladipofascialflapwasmarkedbeforesurgery.(BandC)6monthspost-surgery.Thecosmeticresultwasexcellent.精品课件Modifiedthoracodorsaladipofascialcutaneousflap精品课件精品课件精品课件.A27-year-oldwomanwithbreastcancerlocatedintheupper-outerquadrantoftherightbreast(Case2).(A)Amodifiedthoracodorsaladipofascialcutaneousflapwasdesignedsothatitcouldbeharvestedviaanincisionalongtheanterioraxillarylineandanadditionalbackincision.(B)(C)Sixmonthspostsurgery.Thebilateralincisionswereinconspicuousfromtheanteriorview精品课件精品课件精品课件Thelocalfindings1yearafterthesurgery精品课件Freedermalfatgraft(FDFG)A57-year-oldpatientwithaslimbodyandnon-ptoticbreasts(case2)(A)Preoperativefindings;(B)Anincisionlinewasdrawninredacrossthenipple.Afreedermalfatgraft(FDFG)fromthelowerabdomenwasimplantedinthecylinder-shapeddeformityinthecentralbreast;(C)Fouryearsaftersurgery.精品课件A58-year-oldpatientwithPaget’sdiseaseintherightbreast(case3).(A)Preoperativefindings;(B)Anincisionlinewasdrawninred.Thenipple,butnottheareolawasremovedtogetherwiththebreasttissue.Afreedermalfatgraft(FDFG)fromthelowerabdomenwasharvestedforimplantationintothebreastdefect(15,16);(C)Sevenyearsaftersurgery.精品课件(a)Insitude-epithelializationoftheentireskinpaddlewasperformed.(b)Anellipseoffatanddermiswasremovedbysharpdissection.(c)TheFDFGwasturnedoversothatthedermisfacedthesurfaceofthepectoralismajorandwasfixedsecurelyalongtheentireperiphery.Figure5UltrasonographyrevealedgoodFDFGvolumeoneyearaftertheoperation(F:FDFG,G:normalgland).精品课件Case1:preoperativemarkingsoftheareatoberesectedina53-year-oldpatientwithaT1tumorinthelower-outerquadrantoftheleftbreast.aApurplespotformedaftercoreneedlebiopsy(CNB).Herbreastswerenotptotic.b,cThecancerlesionandthescarinthe6o’clockpositionleftbytheCNBarecircledinred.TheincisionlineisdrawninredalongtheinframammarylineInframammaryadipofascialflap精品课件Operativefindings.aAtongue-shapedadipofascialflap,10cminlength,wasdrawnasablackdottedline.Acrescentofskinwasde-epithelialized.bTheflapwasharvestedviaaninframammaryincisionlineandacaudalwindow.cThede-epithelializedskinwasharvestedtogetherwiththeinframammaryflap.dThetissuewasrolleduptowardsthecranialside精品课件精品课件a,binferioradipofascialtissuerepairSkinincisionwasplacedoninfra-mammaryline.c.Thisflapofafatpadhadawideandlinearpedicleontheinferiormammaryline,andwasbackedbymyofascia(break-lineinschema)oftheanteriorserratusmuscle,andoccasionallytheexternalobliquemuscle.d.Wekeptasmanyperforatingbranchesfromthemusclebodyasposs