Margulies Aaron G, Hochberg Julio, Kepple Julie, Henry-Tillman Ronda S, Westbrook Kent, Klimberg V Suzanne
Division of Breast Surgical Oncology, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Am J Surg. 2005 Dec;190(6):907-12. doi: 10.1016/j.amjsurg.2005.08.019.
We hypothesized that total skin-sparing mastectomy (TSM) including where the skin overlying the nipple and areola is preserved would be oncologically safe and facilitate improved cosmetic reconstruction.
A review (May 2003 through January 2005) was completed on all procedures that were performed through an inframammary incision or a previous scar with reconstruction using Botox, AlloDerm, and a subpectoral tissue implant.
Thirty-one patients had 50 TSMs. Twelve percent (6/50) of TSMs had the skin of the nipple and areola resected: 4 (14% of tumors) because of tumor involvement and 2 (4%) because of skin necrosis. Fourteen percent of patients had other complications: 4% (2/50) had infection and/or flap necrosis and 10% (5/50) had superficial epidermolysis requiring no intervention, for a total complication rate of 18%. Average cosmetic score was 8.5 (range 4 to 10). No recurrences are evident after mean follow-up of 7.9 +/- 5.4 months.
Our short-term experience suggests that TSM has an acceptable complication rate, is theoretically oncologically safe, and facilitates an improved cosmetic result.
我们推测保留乳头和乳晕上方皮肤的全乳皮肤保留切除术（TSM）在肿瘤学上是安全的，并且有助于改善美容重建效果。
对2003年5月至2005年1月期间通过乳房下切口或既往瘢痕进行的所有手术进行回顾，这些手术采用肉毒杆菌毒素、同种异体真皮和胸肌下组织植入物进行重建。
31例患者接受了50次TSM手术。12%（6/50）的TSM手术切除了乳头和乳晕的皮肤：4例（占肿瘤的14%）是因为肿瘤累及，2例（4%）是因为皮肤坏死。14%的患者出现其他并发症：4%（2/50）发生感染和/或皮瓣坏死，10%（5/50）出现无需干预的浅表表皮松解，总并发症发生率为18%。平均美容评分为8.5（范围4至10）。平均随访7.9±5.4个月后未见复发。
我们的短期经验表明，TSM的并发症发生率可接受，理论上在肿瘤学上是安全的，并且有助于改善美容效果。
