Supercharging Abdominal Rectus Musculocutaneous Flap in Breast Reconstruction

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  • Supercharging オ フカシタ フクチョクキン ヒベン オ モチイタ ニュウボウ サイケン
  • Superchargeを付加した腹直筋皮弁を用いた乳房再建

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type:Departmental Bulletin Paper

2013年以降、乳がん全摘後に保険適応となった人工ゲル充填乳房を用いた乳房再建術のまれな合併症として、T細胞型非ホジキンリンパ腫が報告され、同タイプの人工ゲル充填乳房は使用できなくなった。これを受けて、当院では自家組織を用いた乳房再建の症例が増加している。ボリュームのある乳房の場合、腹部を用いた有茎腹直筋皮弁、遊離皮弁が選択されることが多い。有茎皮弁では上腹壁動静脈を血管茎とするが、腹直筋の血行は深下腹壁動静脈優位のため血行が不十分と考えられる硬結が術後に生じることがある。これを改善するため、当科では可能な限り深下腹壁動静脈を胸部のレシピエント血管に吻合してsuperchargeを行い、血行の増強に努めている。遊離皮弁と異なり、皮弁の自由度が制限されるため血管吻合がやや困難であるが、術後は柔らかい乳房が再現されることが期待できる。

With the onset of insurance coverage in 2013, implant-based techniques had been popular for breast reconstruction in Japan until fairly recently. However, possible complications of non-Hodgkin’s lymphoma caused by implant materials led a recall of textured-typed implants for breast reconstruction. Such situation led patients head for breast reconstruction using autologous tissue. In case of well-developed breasts, either rectus abdominal musculocutaneous flap or deep inferior epigastric perforator flap is frequently selected for breast reconstruction. The former flap is well-vascularized but rectus abdominal muscle is used to transpose the flap, which could cause the herniation of the abdominal wall as a complication at late-stage. In the latter flap, since abdominal fat tissue is used, reconstructed breasts are similar to original breasts, while operation periods are relatively long in order to anastomose vessels under microscopy. Besides, thrombosis in anastomosed vessels could cause the total necrosis of reconstructed breasts.To overcome the disadvantages of the both methods, rectus abdominal musculocutaneous flaps anastomosed with vessels in the recipient region (i.e., Supercharged flap) have been developed. Here, we will describe seven cases with supercharged flaps to reconstruct breasts performed in our hospital.

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