乳頭乳輪再建 患者満足度の高い術式選択と術式の要点  [in Japanese] Nipple-Areolar Complex Reconstruction Methods and Their Uses Based on the Patient's Medical Indication and Achievement of a High Psychological Satisfaction Level  [in Japanese]

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Author(s)

    • 海瀬 博史 Kaise Hiroshi
    • 東京医科大学茨城医療センター乳腺科 Department of Breast Oncology, Tokyo Medical University Ibaraki Medical Center
    • 山田 公人 Yamada Kimito
    • 東京医科大学八王子医療センター乳腺科 Department of Breast Oncology, Tokyo Medical University Hachioji Medical Center

Abstract

<p>乳頭乳輪 (Nipple-areolar complex : NAC) 再建は, 乳房再建の仕上げの手術である。NACは乳房の象徴でもあり, これを再建することで乳房は完成し, 患者の再建への満足度は高くなる。NAC再建では突出度・色・形・サイズ・質感・位置の左右対称性が求められる。再建方法には乳頭移植+乳輪tattoo, 乳頭局所皮弁+乳輪tattoo, 乳頭局所皮弁+大腿植皮, 乳頭移植+乳輪移植, 乳頭移植+鼠径部陰部植皮, three-dimensional tattoo (3D tattoo) の6パターンがある。健側NACの形態 (乳頭と乳輪の大きさ・形) と, 再建乳房の状態 (放射線照射・形態) から医学的に適応とされる術式を選択し, さらに患者の背景や希望 (授乳予定・メスを入れてよいか・費用と時間等) を加えて最善な術式を選択することで, 患者満足度はさらに上がる。</p>

<p>Breast reconstruction consists of mound reconstruction and nipple-areolar reconstruction. Nipple-areolar reconstruction is the final step in breast reconstruction. The nipple-areolar complex (NAC) is the primary landmark of the breast, and its reconstruction results in a more perfectly shaped and naturally appearing breast. Thus, NAC reconstruction increases the patients' psychological satisfaction with their breast reconstruction. Importantly, this method requires symmetry in terms of the nipple projection, color, shape, size, texture, and position. There are 6 NAC reconstruction methods : 1) nipple-graft and areolar tattoo, 2) nipple local flap and areolar tattoo, 3) nipple local flap and inner thigh skin graft, 4) nipple and areola graft, 5) nipple-graft and labia or inguinal skin graft, and 6) three-dimensional tattoo (3D tattoo) . The indication of NAC reconstruction is determined by 2 factors : 1) the size and shape of the nipple and areola on the normal side, and 2) the mound condition and irradiation on the reconstructed side. Furthermore, the patient's ability to choose the reconstruction method in consideration of their hope to not disturb the normal side further increases their psychological satisfaction with their breast reconstruction.</p>

Journal

  • Oncoplastic Breast Surgery

    Oncoplastic Breast Surgery 4(1), 8-16, 2019

    Japan Oncoplastic Breast Surgery Society

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