乳房再建時の臍形成

Umbilical Reconstruction of Breast Reconstruction Using a DIEP Flap

はじめに

　自家組織乳房再建において，広背筋皮弁（latissimus dorsi musculocutaneous flap：LD flap），深下腹壁動脈穿通枝皮弁（deep inferior epigastric perforator flap：以下，DIEP flap），大腿深動脈穿通枝皮弁（profunda artery perforator flap：PAP flap），上殿動脈穿通枝皮弁（superior gluteal artery perforator flap：SGAP flap）などさまざまな術式が選択される。その中でもDIEP flapは，比較的大きな乳房の再建に適しており，多く用いられる術式である。DIEP flapを挙上する際に臍をくり抜いて，腹部閉創時に新たに臍の形成を行う。自家組織乳房再建では乳房の完成度のみならず採取部に関しても患者満足度に影響するため，DIEP flapを用いた乳房再建時の腹部採取部の瘢痕や臍の外見も重要な要素である。今回は当院で行っている臍の形成のポイントに関して述べる。

　The deep inferior epigastric perforator artery (DIEP) flap is a suitable option for the reconstruction of relatively large breasts, and it is frequently used in autologous breast reconstruction. During the elevation of a DIEP flap, the umbilicus is incised and a new umbilicus is formed at the time of abdominal closure. The appearance of the abdominal donor scar and umbilicus during breast reconstruction with a DIEP flap is also an important factor, because the completeness of not only the breast but also the donor affects patient satisfaction in autologous breast reconstruction. This article presents a detailed account of our umbilical plication procedures and postoperative revision procedures. Satisfactory outcomes can be anticipated when the design of umbilicus is tailored to the patientʼs original umbilical shape and is performed to the point. In autologous breast reconstruction, the focus is on the breast itself, but it is important to consider that the surgery may also affect the patientʼs satisfaction, as the completeness of the donor site may influence this.