Tattooを先行するclover flap法による乳頭・乳輪再建

Nipple and Areola Reconstruction Using the Clover Flap Technique Before Tattooing

はじめに

　乳癌術後の局所皮弁を用いた乳頭再建は，健側乳頭に傷を付けることなく立体的な乳頭を再建できることがメリットである。一方，経時的に乳頭のprojection（突出）が低くなることがデメリットであり，これまで数多くの局所皮弁法が報告されてきた 1）。乳頭のprojectionの低下は乳頭再建における患者の不満の主な理由であるとされる 2）。

　著者は，長期的にprojectionが維持される局所皮弁の作成を目的に，オリジナルの術式であるclover flap法を考案し実施してきた 3）。本術式の長期経過については術後5年のデータを解析し，clover flap法が良好なprojectionを維持できることを報告した 4）。本稿では，本法の術式とコツについて紹介する。

　The clover flap is the original technique created by the author as a local flap for nipple reconstruction. This technique allows for the long-term maintenance of the nippleʼs projection by maintaining good blood flow conditions and the structure of the skin flap. The flap is designed as a clover-shaped flap oriented at 120°. The nipple projection is twice as high as that of the desired normal side. The width has the same size as that of the normal side. The flap length is set at approx. 20–25 mm. The following are important for the maintenance of the nipple projection: the creation of a well-vascularized skin flap, the establishment of the pedicle farther away from the mastectomy scar, the selection of a surgical technique that involves an oblique scar on the side of the nipple by wrapping the skin flaps, and the inclusion of an appropriate amount of fat tissue inside the reconstructed nipple. Tattooing the nipple precedes surgery. It is easy to stain the flap designs and stain the skin to remain flat and without scarring the nipple. The post-operative nipple projection maintenance rates for this technique for an artificial breast mound were 49.3% at 1 year, 42.3% at 2 years, 40.4% at 3 years, and 39.1% at 5 years. Nipple-areola reconstruction, which is the final touch that gives expression to the reconstructed breast, should be carried out by selecting an appropriate surgical procedure that can maintain good conditions immediately after surgery as well as in the long term.