Wijayanayagam Akushla, Kumar Anjali S, Foster Robert D, Esserman Laura J
Carol Franc Buck Breast Care Center, Department of Surgery, University of California, San Francisco, 1600 Divisidero St, Box 1710, San Francisco, CA 94115-1710, USA.
Arch Surg. 2008 Jan;143(1):38-45; discussion 45. doi: 10.1001/archsurg.143.1.38.
Dissection of subnipple tissue to spare the entire skin envelope of the breast (total skin-sparing mastectomy) is a feasible option in appropriately selected patients and yields an excellent final cosmetic outcome.
Prospective surgical technique outcomes study.
University-based breast care referral center.
Total skin-sparing mastectomy with preservation of the nipple-areola complex was performed in 64 breasts in 43 women. Indications for total skin-sparing mastectomy included prophylaxis (n = 29), invasive carcinoma (n = 24), and ductal carcinoma in situ (n = 11).
Preoperative magnetic resonance imaging was used to select patients and to confirm absence of disease within 2 cm of the nipple. Nipple tissue was serially sectioned at pathologic analysis. Circumareolar/nipple-areola free graft, inframammary, crescentic mastopexy, areola crossing, and radial incisions were used. Immediate reconstruction was performed with implant or tissue expander placement or latissimus dorsi muscle, transverse rectus abdominis muscle, or deep inferior epigastric perforator muscle flaps.
Nipple-areola complex skin survival, implant loss, skin flap necrosis, wound infection, and occult neoplasm.
Nipple-areola complex skin survival was complete in 80% of patients (n = 51) and partial in 16% (n = 10); it was highest with the radial incision at 97% survival (n = 34). Occult ductal carcinoma in situ in the nipple-areola complex was found in 2 patients (3%), and the affected nipple-areola complex was subsequently removed. Other complications included implant loss, total skin-sparing skin flap necrosis, and infection. Although follow-up is limited, no patients have exhibited cancer recurrence.
Total skin-sparing mastectomy is a viable surgical option in selected patients with breast neoplasm and those who choose prophylactic mastectomy, and may increase the willingness of women to consider mastectomy to reduce their risk of breast cancer.
对于经过适当选择的患者，解剖乳头下组织以保留乳房的整个皮肤包膜（全皮肤保留乳房切除术）是一种可行的选择，并且能产生极佳的最终美容效果。
前瞻性手术技术结果研究。
大学附属乳腺护理转诊中心。
对43名女性的64个乳房进行了保留乳头乳晕复合体的全皮肤保留乳房切除术。全皮肤保留乳房切除术的适应证包括预防性手术（n = 29）、浸润性癌（n = 24）和导管原位癌（n = 11）。
术前使用磁共振成像来选择患者并确认乳头2厘米范围内无疾病。乳头组织在病理分析时进行连续切片。采用乳晕周围/乳头乳晕游离移植、乳房下、新月形乳房固定术、乳晕交叉和放射状切口。立即进行重建，采用植入物或组织扩张器植入，或背阔肌、腹直肌横肌或腹壁下深动脉穿支肌皮瓣。
乳头乳晕复合体皮肤存活情况、植入物丢失、皮瓣坏死、伤口感染和隐匿性肿瘤。
80%的患者（n = 51）乳头乳晕复合体皮肤完全存活，16%（n = 10）部分存活；放射状切口的皮肤存活率最高，为97%（n = 34）。在2例患者（3%）中发现乳头乳晕复合体存在隐匿性导管原位癌，随后切除了受影响的乳头乳晕复合体。其他并发症包括植入物丢失、全皮肤保留皮瓣坏死和感染。尽管随访有限，但尚无患者出现癌症复发。
对于选定的乳腺肿瘤患者和选择预防性乳房切除术的患者，全皮肤保留乳房切除术是一种可行的手术选择，可能会增加女性考虑乳房切除术以降低患乳腺癌风险的意愿。
