Rawlani Vinay, Fiuk Julia, Johnson Sarah A, Buck Donald W, Hirsch Elliot, Hansen Nora, Khan Seema, Fine Neil A, Kim John Ys
Division of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Can J Plast Surg. 2011 Winter;19(4):129-33. doi: 10.1177/229255031101900410.
The indications for nipple-sparing mastectomy (NSM) are broadening as more breast surgeons appreciate the utility of preserving the nipple-areolar complex. A number of incision locations are available to the mastectomy surgeon, including inframammary, lateral and periareolar approaches. The present study investigated the effect of these three incisions on reconstructive outcomes; specifically, nipple necrosis.
A single-centre, retrospective review of 37 breast NSM reconstructions treated with immediate tissue expander reconstruction with acellular dermis between 2007 and 2008 was performed. The primary outcome was the incidence of nipple necrosis associated with periareolar, lateral and inframammary incisions. Secondary outcomes were the effects of radiation, chemotherapy and breast size on nipple necrosis.
Thirty-seven breast procedures performed on 20 patients were included in the present study. Periareolar incisions were used in 21 cases, lateral incisions in 14 and inframammary incisions in two. The periareolar incision was associated with a significantly higher incidence of nipple necrosis compared with lateral or inframammary incisions (38.1% versus 6.3%, P=0.028). Patients receiving breast radiation (45.5% versus 15.4%, P=0.066) and those with larger breast size (540.4 g versus 425.7 g, P=0.130) also demonstrated a modest trend toward an increased rate of nipple necrosis.
The periareolar incision results in a higher rate of nipple necrosis following NSM and immediate tissue expander breast reconstruction. Using the lateral or inframammary incision reduces the incidence of nipple necrosis and may help improve overall reconstructive and cosmetic outcomes.
随着越来越多的乳腺外科医生认识到保留乳头乳晕复合体的实用性，保留乳头的乳房切除术（NSM）的适应证正在扩大。乳房切除手术医生有多种切口位置可供选择，包括乳房下、外侧和乳晕周围入路。本研究调查了这三种切口对重建效果的影响；具体而言，即乳头坏死情况。
对2007年至2008年间接受即刻组织扩张器联合脱细胞真皮重建治疗的37例乳房NSM重建病例进行了单中心回顾性研究。主要结局是与乳晕周围、外侧和乳房下切口相关的乳头坏死发生率。次要结局是放疗、化疗和乳房大小对乳头坏死的影响。
本研究纳入了对20例患者实施的37例乳房手术。其中21例采用乳晕周围切口，14例采用外侧切口，2例采用乳房下切口。与外侧或乳房下切口相比，乳晕周围切口的乳头坏死发生率显著更高（38.1%对6.3%，P = 0.028）。接受乳房放疗的患者（45.5%对15.4%，P = 0.066）以及乳房体积较大的患者（540.4 g对425.7 g，P = 0.130）乳头坏死率也有适度升高趋势。
乳晕周围切口导致NSM及即刻组织扩张器乳房重建术后乳头坏死率更高。采用外侧或乳房下切口可降低乳头坏死发生率，并可能有助于改善整体重建和美容效果。
