目的探讨DIEP皮瓣在乳房再造术中的设计与塑形方法以及术后美学效果。方法对109例接受延期单侧行DIEP皮瓣乳房再造的乳腺癌患者,术中通过测量对侧乳房垂度及形态参数,镜像设计并塑形皮瓣;术后6个月利用计算机三维扫描技术对乳房对称性进行随访。结果参照健侧乳房形态和垂度,设计DIEP皮瓣半月形24例,半圆形42例,梭形43例。术后6个月计算机三维扫描结果显示,两侧乳房投影及乳头位置无明显差异。而与健侧相比,再造侧乳房具有较大的容积(P<0.01)和较高的凸度(P<0川),能够为乳头再造和瘢痕改形预留二期手术的空间。结论对于拟行自体组织乳房再造,但腹部组织量有限的女性患者,采用个性化DIEP皮瓣设计及塑形原则,可以最大程度地获得令人满意、对称的乳房美学效果,值得临床推广应用。 Objective To explore the design and shaping methods of DIEP flaps in breast reconstruction and the postoperative aesthetic effects. Methods 109 cases of breast cancer patients undergoing delayed unilateral DIEP flap reconstructive surgery were performed by measuring the contralateral breast sagging and morphological parameters during surgery. The flaps were mirror-imaged and shaped; the computerized three-dimensional scanning technique was used 6 months after operation. Breast symmetry was followed. Results With reference to the shape and sag of the healthy breast, 24 cases of semilunar DIEP flaps, 42 cases of semicircular, and 43 cases of spindle were designed. The results of computer three-dimensional scan after 6 months showed no significant differences in the projection of the breast and the position of the nipple. Compared with the contralateral side, the reconstructed lateral breast had a larger volume (P<0.01) and a higher convexity (P