Ho Chiu M, Mak Colin K L, Lau Yvonne, Cheung Wing Y, Chan Miranda C M, Hung Wai K
Department of Surgery, Division of Plastic Surgery, Kwong Wah Hospital, Hong Kong SAR, China.
Ann Surg Oncol. 2003 Mar;10(2):102-7. doi: 10.1245/aso.2003.05.001.
There is concern about the oncological safety of preserving most of the breast skin in skin-sparing mastectomy (SSM). Most supportive evidence for SSM evaluates the local recurrence rate on clinical follow-up.
The skin and 10 mm of the subcutaneous tissue of 30 total mastectomy specimens were studied with a step-serial sectioning technique. The incidence and mode of involvement of the skin and subcutaneous tissue were recorded in detail. This was correlated with other clinical and pathologic parameters.
The incidence of skin involvement outside the nipple-areola complex was 20% (6 of 30). This was significantly related to the clinical T stage, site of the tumor, skin tethering, pathologic tumor size, and perineural infiltration. When the effects of both skin and subcutaneous tissue involvement were considered, the incidence of skin-flap involvement outside the nipple-areola complex was 23% (7 of 30). The significant parameters related to skin-flap involvement were skin tethering (75% vs. 15%; P <.05), pathologic tumor size (P <.03), and perineural infiltration (63% vs. 9%; P <.01).
It would be oncologically safe to perform SSM in T1 and T2 tumors, because the chance of skin involvement is small. It is safe to preserve the skin overlying the tumor if there is no skin tethering.
保留大部分乳房皮肤的保乳根治术（SSM）的肿瘤学安全性受到关注。SSM的大多数支持性证据是通过临床随访评估局部复发率。
采用步进连续切片技术对30例全乳切除标本的皮肤及10毫米皮下组织进行研究。详细记录皮肤和皮下组织受累的发生率及方式，并与其他临床和病理参数进行关联分析。
乳头乳晕复合体以外皮肤受累的发生率为20%（30例中的6例）。这与临床T分期、肿瘤部位、皮肤粘连、病理肿瘤大小及神经周围浸润显著相关。当同时考虑皮肤和皮下组织受累的影响时，乳头乳晕复合体以外皮瓣受累的发生率为23%（30例中的7例）。与皮瓣受累相关的显著参数为皮肤粘连（75%对15%；P<.05）、病理肿瘤大小（P<.03）及神经周围浸润（63%对9%；P<.01）。
对于T1和T2期肿瘤行SSM在肿瘤学上是安全的，因为皮肤受累的几率较小。如果没有皮肤粘连，保留肿瘤表面的皮肤是安全的。
