Simmons Rache M, Adamovich Tara L
Department of Surgery, The New York Presbyterian Hospital, Weill Medical College of Cornell University, 451 East 61st Street, New York, NY 10021, USA.
Surg Clin North Am. 2003 Aug;83(4):885-99. doi: 10.1016/S0039-6109(03)00035-5.
The cosmetic appearance of the reconstructed breast is largely dependent upon the quantity of breast skin which remains after mastectomy. Leaving behind as much skin as is possible significantly improves the natural appearance of the reconstruction and reduces procedures required on the contralateral breast to achieve symmetry. SSM with immediate reconstruction offers superior aesthetic results to NSSM, with similar LR rates. As most recurrences will occur in chest wall skin, the ability to detect local recurrence is not impaired. The incidence of local wound complications with SSM is comparable to NSSM. It has been demonstrated that sentinel lymph node biopsy and axillary dissection can be performed adequately in SSM. There is no contraindication to postoperative adjuvant chemotherapy and radiation therapy. There are some groups of patients for whom SSM is not indicated, such as patients with inflammatory carcinoma. SSM should be considered for selected patients with breast cancer in conjunction with all types of immediate reconstruction. In conclusion, numerous studies support the use of SSM on selected patients as an oncologically acceptable procedure with superior cosmetic results when compared with traditional NSSM.
重建乳房的外观很大程度上取决于乳房切除术后剩余的乳房皮肤量。尽可能多地保留皮肤可显著改善重建后的自然外观，并减少对侧乳房为达到对称所需的手术。保留皮肤的乳房切除术并即刻重建在美学效果上优于非保留皮肤的乳房切除术，局部复发率相似。由于大多数复发将发生在胸壁皮肤，因此检测局部复发的能力并未受损。保留皮肤的乳房切除术的局部伤口并发症发生率与非保留皮肤的乳房切除术相当。已经证明，在保留皮肤的乳房切除术中可以充分进行前哨淋巴结活检和腋窝清扫。术后辅助化疗和放疗没有禁忌证。有一些患者群体不适合进行保留皮肤的乳房切除术，例如炎性乳腺癌患者。对于选定的乳腺癌患者，应考虑保留皮肤的乳房切除术并结合所有类型的即刻重建。总之，大量研究支持对选定患者使用保留皮肤的乳房切除术，与传统的非保留皮肤的乳房切除术相比，这是一种在肿瘤学上可接受的手术，具有更好的美容效果。
