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1、Adipofascial flap,11,基于乳腺切除的量及手术相对难度将OPS分为两级,保乳术后乳房整形,Volume Replacement 用非乳腺织进行替代填充,Volume replacement techniques Adipofascial flap Lateral thoracodorsal flap Thoracoepigastric flap Intercostal artery perforator (ICAP)flap Thoracodorsal artery perforator (TDAP) flap Latissimus dorsi (LD) myocutaneo
2、us flap,Procedure for harvesting the C-shaped thoracodorsal ap and repair of the defect. (A) By the same skin incision upon the middle axillary line, we can do the partial resection of the breast, axillary lymph node dissection, and get the adipofascial ap. (B) A C-shaped thoracodorsal adipofascial
3、ap was harvested after local resection of the breast and axillary lymph node dissection. (C) Attaching the fascia of the latissimus dorsi muscle to the adipose tissue makes the harvested tissue rm. (D) The ap is rotated to the medial side to ll the defect. We sometimes roll or gather it to reconstru
4、ct to the breast mound.,Thoracodorsal adipofascial ap,42-year-old lady with breast cancer located on upper outer-quadrant of the right breast (Case 1) (A) A resected area of the breast with the gross margin as 3 cm and a C-shaped thoracodorsal adipofascial ap was marked before surgery. (B and C) 6 m
5、onths post-surgery. The deformity of both breast and donor site is inconspicuous.,6-year-old lady with breast cancer located on upper outer-quadrant of the right breast (Case 2) . (A) A resected area of the breast with the gross margin as 3 cm and a C-shaped thoracodorsal adipofascial ap was marked
6、before surgery. (B and C) 6 months post-surgery. The cosmetic result was excellent.,Modied thoracodorsal adipofascial cutaneous ap,.A 27-year-old woman with breast cancer located in the upper-outer quadrant of the right breast (Case 2) . (A) A modied thoracodorsal adipofascial cutaneous ap was desig
7、ned so that it could be harvested via an incision along the anterior axillary line and an additional back incision. (B)(C) Six months postsurgery. The bilateral incisions were inconspicuous from the anterior view,The local ndings 1 year after the surgery,Free dermal fat graft (FDFG),A 57-year-old pa
8、tient with a slim body and non-ptotic breasts (case 2) (A) Preoperative findings; (B) An incision line was drawn in red across the nipple. A free dermal fat graft (FDFG) from the lower abdomen was implanted in the cylinder-shaped deformity in the central breast; (C) Four years after surgery.,A 58-ye
9、ar-old patient with Pagets disease in the right breast (case 3). (A) Preoperative findings; (B) An incision line was drawn in red. The nipple, but not the areola was removed together with the breast tissue. A free dermal fat graft (FDFG) from the lower abdomen was harvested for implantation into the
10、 breast defect (15,16); (C) Seven years after surgery.,(a) In situ de-epithelialization of the entire skin paddle was performed. (b) An ellipse of fat and dermis was removed by sharp dissection. (c) The FDFG was turned over so that the dermis faced the surface of the pectoralis major and was xed sec
11、urely along the entire periphery.,Figure 5 Ultrasonography revealed good FDFG volume one year after the operation (F: FDFG, G: normal gland).,Case 1: preoperative markings of the area to be resected in a 53-year-old patient with a T1 tumor in the lower-outer quadrant of the left breast. a A purple s
12、pot formed after core needle biopsy (CNB).Her breasts were not ptotic. b, c The cancer lesion and the scar in the 6 oclock position left by the CNB are circled in red. The incision line is drawn in red along the inframammary line,Inframammary adipofascial ap,Operative ndings. a A tongue-shaped adipo
13、fascial ap,10 cm in length, was drawn as a black dotted line. A crescent of skin was de-epithelialized. b The ap was harvested via an inframammary incision line and a caudal window. c The de-epithelialized skin was harvested together with the inframammary ap. d The tissue was rolled up towards the c
14、ranial side,a,b inferior adipofascial tissue repair Skin incision was placed on infra-mammary line. c. This flap of a fat pad had a wide and linear pedicle on the inferior mammary line, and was backed by myofascia (break-line in schema) of the anterior serratus muscle, and occasionally the external
15、oblique muscle . d.We kept as many perforating branches from the muscle body as possible. As shown in schema, we converted this flapinto dead space, sutured the fascia to the stump of residual breast tissue, and set up to refill the defect of the moun,adipose tissue from the subclavicular area,Thank you,