Parsiyel Meme Defektlerinin Rekonstrüksiyonu
Özet
Meme koruyucu cerrahinin popülerlik kazanması, onkolojik olarak güvenli cerrahi sınırların korunmasının yanı sıra postoperatif oluşan defektlerin onarılması amacıyla rekonstrüktif tekniklerin gelişmesini sağlamıştır. Parsiyel meme defektlerinin rekonstrüksiyonunda temel olarak volüm değiştirme (memenin kendi özdokularıyla şekillendirme) ve volüm replasmanı (meme dışı dokuların kullanımı) olmak üzere iki ana tedavi yöntemi uygulanmaktadır. Volüm değiştirme teknikleri genellikle yeterli parankim dokusuna sahip, orta veya büyük pitozik memelerde estetik meme küçültme ve dikleştirme prensipleriyle gerçekleştirilirken; küçük memelerde veya büyük defektlerde volüm replasmanı tercih edilmektedir. Hacim ikamesi amacıyla flep cerrahisine alternatif olarak kullanılan otolog yağ grefti (lipofilling) uygulamaları, dokuya hacim ve simetri kazandırarak kozmetik sonuçları önemli ölçüde iyileştirmektedir. Ayrıca lateral göğüs duvarından kaldırılan lokal transpozisyon flepleri, kas dokusunun feda edilmediği torakodorsal arter perforatör (TDAP) flepleri ve lateral torasik arter perforatör (LTAP) flepleri ile geniş doku hacmi sağlayan geleneksel latissimus dorsi kas-deri flebi, defektin yerine ve boyutuna göre başarıyla uygulanan diğer önemli seçeneklerdir. Onkoplastik yaklaşımlarla yapılan erken rekonstrüksiyonlar radyoterapinin olumsuz etkilerini ve cerrahi skarları azaltsa da, cerrahi sınır pozitifliği riski bulunan seçilmiş vakalarda geç veya gecikmeli erken rekonstrüksiyon tekniklerine de başvurulabilmektedir.
The rapid increase in breast-conserving surgery has driven the development of advanced reconstructive techniques designed to repair postoperative defects while ensuring oncologically safe resection margins. Reconstruction of partial breast defects primarily utilizes two distinct treatment modalities: volume displacement, which reshapes the breast using its autologous tissue, and volume replacement, which incorporates non-breast local or distant tissues. Volume displacement techniques are ideally suited for medium-to-large ptotic breasts with sufficient remaining parenchyma, leveraging standard reduction mammoplasty and mastopexy designs; conversely, volume replacement is indicated for smaller breasts or larger relative defects. As a prominent alternative to complex flap surgeries, autologous fat grafting (lipofilling) significantly enhances cosmetic outcomes by restoring volume, contour, and symmetry to the treated tissue. Additionally, local transposition flaps from the lateral chest wall, muscle-sparing thoracodorsal artery perforator (TDAP) flaps, lateral thoracic artery perforator (LTAP) flaps, and robust latissimus dorsi myocutaneous flaps provide reliable options based on defect location and size. While immediate reconstruction optimizes patient quality of life and mitigates radiation-induced tissue fibrosis, delayed or delayed-immediate approaches remain crucial for cases with a high risk of positive surgical margins.
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