Hybridrekonstruktion der Brust nach Mastektomie

Zusammenfassung

Die Herausforderung nach Mastektomie ist die sichere Rekonstruktion der Brust von adäquater Größe und Form, welche weich, symmetrisch und sensibel ist („6 S“: size, shape, symmetry, softness, sensation, safety). Traditionell wurden Patientinnen zwei rekonstruktive Verfahren angeboten, nämlich die Implantat-basierte vs. autologe Brustrekonstruktion. Obgleich dieses binäre Vorgehen für die Mehrzahl der Patientinnen adäquat ist, so verbleibt ein Anteil, für welche dieser recht einfache Entscheidungsalgorithmus keine optimale Lösung darstellt. Hier bietet die Hybdridrekonstruktion, d. h. die Kombination von Implantat und mikrochirurgischer Lappenplastik, die Möglichkeit Patientinnen eine individualisierte Rekonstruktion anzubieten, welche die einzelnen Limitationen der traditionellen Verfahren durch Kombination vermeidet. Insofern erweitert die Hybridrekonstruktion das Indikationsspektrum der mikrochirurgischen Brustrekonstruktion und stellt die Vorteile der autologen Brustrekonstruktion einer größeren Patientenpopulation zur Verfügung. In diesem Beitrag wird das operative Vorgehen der Hybridrekonstruktion vorgestellt mitsamt einer Diskussion wichtiger Parameter, inklusive der Implantatloge, Zeitpunkt der Implantatplatzierung, sowie Einfluss der Radiatio.

Abstract

The challenge following mastectomy is to safely reconstruct breasts of adequate size, shape, symmetry, softness, and sensation (“6 S”). Historically, patients have been offered two reconstructive modalities, namely either implant-based or autologous reconstruction. While this binary approach is appropriate for most patients, there remain a subset of patients for whom this simplistic approach is not suitable. For these, hybrid reconstruction, i. e., the combination of an implant with microsurgical tissue transfer, offers the possibility of individualised reconstruction, which avoids some of the limitations of traditional approaches. Hybrid breast reconstruction, thus expands the indications for microsurgical reconstruction and offers the advantages of this reconstructive modality to a larger patient population. In this article, the surgical technique of hybrid breast reconstruction is described, along with a discussion of important parameters related to this reconstructive modality, including plane and timing of implant placement, and the issue of radiotherapy.

Schlüsselwörter

Brustrekonstruktion - Hybridrekonstruktion - Mikrochirurgie - Implantat - freie Lappenplastiken, Mikrochirurgie

Key words

Breast reconstruction - Hybrid reconstruction - microsurgery - breast implant - free flaps

Publication History

Received: 24 January 2022

Accepted: 19 March 2022

Article published online:
22 June 2022

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