② If the areola of both nipples is missing, the labia minora or toe abdomen can be transplanted to reconstruct the nipple; Nipples can also be reconstructed by transplanting auricle skin and cartilage from earlobe.
Reconstruction of nipple areola with skin flap provides a large amount of tissue, good blood supply, good sensory recovery and a certain height of nipple. In addition, dermal scar tissue or tissue substitute can be used to fill the nipple to increase its convexity.
Methods: The time of breast reconstruction was divided into immediate breast reconstruction and delayed breast reconstruction. Immediate breast reconstruction refers to breast reconstruction and repair at the same time as mastectomy. It has the following advantages that can not be ignored: 1) resection and reconstruction can be completed at one time, reducing hospitalization time and cost; 2) Patients don't have to experience the psychological pain of losing their breasts; 3) The shape of the reconstructed breast will be better. It will not delay adjuvant radiotherapy or chemotherapy, and will not increase local recurrence. Except for patients with distant metastasis or surgical contraindications, patients in stage ⅰ, ⅱ and ⅲ are suitable for immediate breast reconstruction.
Delayed breast reconstruction can be performed at any time after mastectomy, usually 9 months after mastectomy, because chemotherapy and radiotherapy can be completed during this period. Some advanced patients need a lot of radiotherapy and chemotherapy, and delayed breast reconstruction can be considered after the condition is stable. The methods of breast reconstruction can be divided into two categories: (1) breast prosthesis, namely silica gel, saline breast prosthesis and dilator; (2) Autologous tissue.
The reconstructed breast is small in size, locally covered with good soft tissue, young and unwilling to sacrifice autologous tissue in other parts of the body. The method is to place the prosthesis filled with silica gel, silica gel or normal saline under the skin flap or pectoralis major muscle after mastectomy. If after mastectomy, the local tissue can't provide enough cavity to accommodate the prosthesis with the required size, a skin dilator can be placed first, and water can be injected regularly after operation. When a sufficient cavity is formed, the dilator can be replaced with a breast prosthesis again.
Breast reconstruction with autologous tissue is breast reconstruction with autologous tissue as donor site and tissue transplantation. The reconstructed breast with autologous tissue transplantation has a lasting effect and a realistic appearance. Has the following advantages: 1) can make full use of the patient's autologous tissue; 2) avoiding a series of complications that may be caused by prosthesis; 3) Good texture, easy shaping and good drooping feeling, which can correct subclavian depression and axillary anterior wall defect; 4) It can not only tolerate postoperative radiotherapy, but also be suitable for patients who have received radiotherapy and have undergone extensive resection due to recurrence; 5) Autologous tissue with good blood supply can promote the healing of bad wounds and ulcers. According to its tissue source, it can be divided into abdomen, buttocks, back and thighs. According to its transfer mode, it can be divided into pedicled transfer and free transplantation.