Academic Surgery, Royal Marsden NHS Foundation Trust, London, UK.
Br J Surg. 2010 Mar;97(3):305-16. doi: 10.1002/bjs.6970.
Although effective local control is the primary goal of surgery for breast cancer, the long-term aesthetic outcome is also important. Nipple-sparing mastectomy aims to address this, but there is no consensus on its clinical application. Evidence relating to oncological safety, surgical technique and early data on aesthetic outcome was reviewed.
The review was based on a PubMed search using the terms 'nipple-sparing' or 'subcutaneous mastectomy' and 'breast cancer'.
Large pathological studies report occult nipple involvement with cancer in 5.6-31 per cent, reflecting variation in inclusion criteria. Recent clinical series with careful patient selection report local recurrence in less than 5 per cent of patients. The incidence of cancer in the retained nipple after risk-reducing mastectomy is less than 1 per cent. Nipple necrosis rates range up to 8 and 16 per cent for total and partial necrosis respectively. Variations in outcome result from differences in extent of resection, placement of incisions and type of breast reconstruction.
Nipple-sparing mastectomy is an acceptable technique for women undergoing risk-reducing mastectomy. In the therapeutic setting, it may be offered to patients with smaller tumours far from the nipple and favourable pathological features. Women should be counselled about nipple necrosis and the potential for local recurrence.
尽管乳腺癌手术的主要目标是实现有效的局部控制，但长期的美学效果也很重要。保留乳头的乳房切除术旨在解决这个问题，但在其临床应用方面尚未达成共识。本文对肿瘤学安全性、手术技术和早期美学结果数据进行了回顾。
本综述基于使用“nipple-sparing”或“subcutaneous mastectomy”和“breast cancer”这两个术语在 PubMed 上进行的搜索。
大型病理研究报告称，隐匿性乳头受累的癌症发生率为 5.6%-31%，这反映了纳入标准的差异。最近的临床系列研究对患者进行了精心选择，报告局部复发率低于 5%。保乳术后保留乳头的癌症发生率小于 1%。乳头坏死的发生率分别高达 8%和 16%，分别为完全性和部分性坏死。结果的差异源于切除范围、切口位置和乳房重建类型的不同。
保留乳头的乳房切除术是接受保乳切除术的女性可接受的一种手术技术。在治疗性环境中，对于远离乳头且具有良好病理特征的小肿瘤患者，可以向其提供该手术。应告知女性有关乳头坏死和局部复发的潜在风险。
