Department of Plastic Surgery, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA.
Plast Reconstr Surg. 2010 Mar;125(3):818-29. doi: 10.1097/PRS.0b013e3181ccdaa4.
Nipple-sparing mastectomy has become an accepted treatment for appropriately selected breast cancers. No reports have correlated patient satisfaction following nipple-sparing mastectomy with objective observer assessments.
From 2001 to 2008, nipple-sparing mastectomy and immediate reconstruction were performed on 141 patients. After institutional review board approval, patients completed questionnaires rating their satisfaction with various aspects of their nipple-areola complex using a Likert-type scale. Three independent observers then reviewed the nipple-areola complex in 34 patients and rated the outcome using the same scale.
The survey completion rate was 53 percent and the mean follow-up was 50.4 months (range, 9 to 100 months). A majority of patients rated appearance, symmetry, color, position, and texture as good or excellent. A majority of patients rated sensation and arousal as fair or poor. Fifty-seven patients (73.1 percent) stated they would definitely undergo nipple-sparing mastectomy again. Patients with larger volumes of breast tissue removed (p = 0.010), larger preoperative body mass index (p = 0.034), or larger tissue expander volumes (p = 0.007) reported lower satisfaction. Patient assessments for appearance, color, symmetry, and position correlated with those of objective observers.
The authors' study is the largest series to address patient satisfaction with the nipple-areola complex following nipple-sparing mastectomy and the only one to correlate patient self-assessment with assessment by independent observers. Overall, patients were very satisfied with appearance of the nipple-areola complex and most would choose nipple-sparing mastectomy again. A majority of patients rated sensation as fair or poor, with sensation constituting the most frequent aspect of the nipple-areola complex that patients would change. Larger body mass index, expander volumes, and volume of breast tissue removed may predict dissatisfaction postoperatively.
保乳乳头切除术已成为一种被广泛接受的治疗方法，适用于选择合适的乳腺癌患者。目前还没有报道将保乳乳头切除术后患者的满意度与客观观察者的评估结果相关联。
在 2001 年至 2008 年期间，对 141 例患者进行了保乳乳头切除术和即刻重建。经机构审查委员会批准，患者使用李克特量表对他们的乳头乳晕复合体的各个方面的满意度进行了问卷调查。然后，三位独立观察者对 34 例患者的乳头乳晕复合体进行了评估，并使用相同的量表进行了评分。
调查完成率为 53%，平均随访时间为 50.4 个月（范围 9 至 100 个月）。大多数患者对外观、对称性、颜色、位置和质地的评分均为良好或优秀。大多数患者对感觉和唤起的评分均为一般或较差。57 例（73.1%）患者表示他们肯定会再次接受保乳乳头切除术。乳房组织切除量较大的患者（p = 0.010）、术前体重指数较大的患者（p = 0.034）或组织扩张器体积较大的患者（p = 0.007）报告的满意度较低。患者对外观、颜色、对称性和位置的评估与客观观察者的评估相关。
作者的研究是针对保乳乳头切除术后患者对乳头乳晕复合体满意度进行评估的最大系列研究，也是唯一将患者自我评估与独立观察者评估相关联的研究。总体而言，患者对乳头乳晕复合体的外观非常满意，大多数患者会再次选择保乳乳头切除术。大多数患者对感觉的评分均为一般或较差，感觉是患者最常改变的乳头乳晕复合体的方面。较大的体重指数、扩张器体积和切除的乳房组织量可能预示着术后不满意。
