Department of Surgery, Tulane University, New Orleans, Louisiana 70115, USA.
Breast J. 2013 Mar-Apr;19(2):173-9. doi: 10.1111/tbj.12078. Epub 2013 Jan 22.
Optimizing cosmesis is a common goal of breast surgery. In support of immediate breast reconstruction, nipple-sparing techniques have evolved. There is still a lack of agreement on the optimal technique and skin flap necrosis can be problematic. In this study, we review our experience with 340 NSM. Between March 2006 and February 2011, 340 NSMs were performed. Mammography, ultrasonography and magnetic resonance imaging were reviewed. Patient demographics and surgical techniques were reviewed. Anatomic observations were made and supported by breast images. A total of 340 NSMs in 231 patients by a single surgeon (AJS) were reviewed. Risk reduction was the indication for surgery in 59% with 50 patients (21.6%) testing positive for a BRCA1/2 gene mutation. There were two flap losses and 14 hematomas. Complete nipple necrosis occurred in three cases (0.8%) and partial loss in six patients. Recommendations are made to reduce the risk of nipple necrosis included the following: (a) preserving major perforating vessels (b) elevating skin flaps in the plane between the subcutaneous fat and the breast glandular tissue (c) the use of incisions that do not devascularize the nipple-areola complex. Nipple-sparing mastectomy can be performed with an acceptably low risk of nipple necrosis. Attention to detail including preserving major perforating vessels, elevating skin flaps in the appropriate plane and careful attention to incision planning are all required for a consistently good cosmetic outcome.
优化美容效果是乳房手术的共同目标。为了支持即刻乳房重建，保留乳头技术已经发展起来。对于最佳技术仍缺乏共识，皮瓣坏死可能是一个问题。在这项研究中，我们回顾了我们 340 例 NSM 的经验。在 2006 年 3 月至 2011 年 2 月期间，进行了 340 例 NSM。回顾了乳房 X 线摄影、超声和磁共振成像。回顾了患者人口统计学和手术技术。进行了解剖观察，并通过乳房图像得到支持。由一位外科医生（AJS）对 231 例患者的 340 例 NSM 进行了回顾。59%的患者因降低风险而行手术，其中 50 例（21.6%）BRCA1/2 基因突变检测阳性。有两例皮瓣坏死，14 例血肿。有 3 例（0.8%）完全乳头坏死，6 例部分坏死。为降低乳头坏死的风险，提出以下建议：（a）保留主要穿支血管；（b）在皮下脂肪和乳腺组织之间的平面上提起皮瓣；（c）使用不会使乳头乳晕复合体缺血的切口。保留乳头的乳房切除术可以以可接受的低风险发生乳头坏死。需要注意细节，包括保留主要穿支血管、在适当的平面提起皮瓣以及仔细注意切口规划，以获得一致良好的美容效果。
