Department of Surgery, College of Medicine, Asan Medical Center, University of Ulsan, Seoul, Korea.
Ann Surg. 2010 Mar;251(3):493-8. doi: 10.1097/SLA.0b013e3181c5dc4e.
The present study evaluated the oncological safety and technical outcomes following nipple areola skin-sparing mastectomy (NASSM), skin-sparing mastectomy (SSM), and mastectomy.
Cosmetic issues associated with breast cancer surgery are important. The original SSM technique included removal of the gland and the nipple areola complex (NAC). However, the risk of tumor involvement of the NAC has been overestimated.
This retrospective study included 520 patients who underwent SSM (368 patients) or NASSM (152 patients) with immediate breast reconstruction using a pedicled transverse rectus abdominis musculocutaneous (TRAM) flap, and 1990 patients who underwent a mastectomy between July 2001 and December 2006. The indications for NASSM were any stage, any tumor size, and any tumor areola distance. Briefly, the NAC was preserved when the shape, color, and palpation of the nipple were normal.
The median follow-up durations for NASSM and SSM were 60 and 67 months, respectively. Complete nipple areola necrosis developed in 11 (9.6%) NASSM patients. The 5-year disease-free survival rates were 89% and 87.2% for NASSM and SSM, respectively (P = 0.695). The 5-year overall survival rates were similar for NASSM and SSM (97.1% and 95.8%, respectively; P = 0.669). Local failure occurred in 3 (2%) NASSM and 3 (0.8%) SSM patients (P = 0.27). There were 2 (1.3%) nipple areola recurrences in NASSM patients. The LRRs were similar for NASSM and mastectomy patients.
NASSM with immediate transverse rectus abdominis musculocutaneous reconstruction is a viable surgical treatment in breast cancer patients in any stage. Recurrence and complication rates for NASSM were similar to those for standard surgical breast cancer treatments.
本研究评估了保留乳头乳晕皮肤的乳房切除术（NASSM）、保留皮肤的乳房切除术（SSM）和乳房切除术的肿瘤安全性和技术结果。
与乳腺癌手术相关的美容问题很重要。最初的 SSM 技术包括切除腺体和乳头乳晕复合体（NAC）。然而，NAC 肿瘤受累的风险被高估了。
本回顾性研究纳入了 520 例接受 SSM（368 例）或 NASSM（152 例）治疗的患者，这些患者均采用带蒂横形腹直肌肌皮瓣（TRAM）即刻乳房重建，并纳入了 1990 例 2001 年 7 月至 2006 年 12 月期间接受乳房切除术的患者。NASSM 的适应证为任何分期、任何肿瘤大小和任何肿瘤乳晕距离。简要地说，当乳头的形状、颜色和触诊正常时，保留 NAC。
NASSM 和 SSM 的中位随访时间分别为 60 个月和 67 个月。11 例（9.6%）NASSM 患者发生完全乳头乳晕坏死。NASSM 和 SSM 的 5 年无病生存率分别为 89%和 87.2%（P=0.695）。NASSM 和 SSM 的 5 年总生存率相似（分别为 97.1%和 95.8%；P=0.669）。3 例（2%）NASSM 和 3 例（0.8%）SSM 患者发生局部失败（P=0.27）。NASSM 患者中有 2 例（1.3%）发生乳头乳晕复发。NASSM 和乳房切除术患者的 LRR 相似。
对于任何分期的乳腺癌患者，即刻横形腹直肌肌皮瓣重建的 NASSM 是一种可行的手术治疗方法。NASSM 的复发率和并发症发生率与标准的乳腺癌手术治疗相似。
