Division of Plastic Surgery, Geffen School of Medicine at U.C.L.A., Los Angeles, CA, USA.
Ann Surg Oncol. 2012 Oct;19(10):3171-6. doi: 10.1245/s10434-012-2528-7. Epub 2012 Jul 25.
Nipple-sparing mastectomy (NSM) improves cosmetic outcome of mastectomy, but many patients are not candidates for this procedure because of concerns about nipple-areolar viability. Surgical delay is a technique that has been used for more than 400 years to improve survival of skin flaps. We used a surgical delay procedure to improve nipple viability in patients who were identified to be at high risk for nipple necrosis following NSM.
Patients at high risk for nipple necrosis following NSM underwent a surgical delay procedure 7-21 days prior to mastectomy. Subareolar biopsy and sentinel node biopsy, if indicated, were performed at the time of the delay procedure. Nipple viability was assessed before and after NSM. If the subareolar biopsy revealed malignancy, the NAC was removed at the time of mastectomy.
31 NAC in 20 patients underwent surgical delay. All of the NAC subjected to a surgical delay survived following the delay procedure. In 2 patients, the subareolar biopsy was positive and 3 NAC were removed at the time of mastectomy (1 for purposes of symmetry). Of the 28 delayed NAC left at the time of NSM, all survived the post-mastectomy course.
A procedure to surgically delay the NAC 7-21 days prior to NSM is demonstrated to ensure viability of NAC in patients previously thought to be at high risk for nipple loss.
保留乳头的乳房切除术（NSM）改善了乳房切除术的美容效果，但由于对乳头乳晕血供的担忧，许多患者不适合进行该手术。手术延迟是一种已经使用了 400 多年的技术，用于提高皮瓣的存活率。我们使用手术延迟技术来提高 NSM 后乳头坏死风险较高的患者的乳头血供。
NSM 后乳头坏死风险较高的患者在乳房切除术前 7-21 天进行手术延迟。如果需要，在延迟手术时进行乳晕下活检和前哨淋巴结活检。在 NSM 前后评估乳头血供。如果乳晕下活检显示恶性肿瘤，则在乳房切除时切除 NAC。
20 例患者的 31 个 NAC 进行了手术延迟。所有接受手术延迟的 NAC 在延迟手术后都存活下来。2 例患者乳晕下活检阳性，3 个 NAC 在乳房切除时切除（1 个为了对称）。在 NSM 时留下的 28 个延迟 NAC 中，所有的都在乳房切除术后存活下来。
在 NSM 前 7-21 天进行 NAC 的手术延迟，可确保先前认为乳头丢失风险较高的患者的 NAC 存活。
