Piper Merisa, Peled Anne Warren, Foster Robert D, Moore Dan H, Esserman Laura J
From the *Division of Plastic and Reconstructive Surgery, Department of Surgery, †Department of Epidemiology and Biostatistics, and ‡Division of Breast Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA.
Ann Plast Surg. 2013 Apr;70(4):435-7. doi: 10.1097/SAP.0b013e31827e5333.
Despite the potential aesthetic and psychological benefits of total skin-sparing mastectomy (TSSM) with preservation of the nipple-areolar complex (NAC) skin, there is still reluctance to use the technique due to concern for increased recurrence rates or higher postoperative complication rates. The rapidly expanding literature describing outcomes after TSSM enables a comprehensive review of recurrence rates and surgical complications.
Studies describing nipple-sparing or TSSM were identified from the MEDLINE and Cochrane databases. Studies that reported oncologic outcomes and/or data on postoperative complications were included.
Twenty-seven studies were identified that met inclusion criteria, representing a total of 3331 mastectomies. Review of oncologic outcomes in the 10 studies (representing 1148 mastectomies) with documented mean/median follow-up of 2 years demonstrated an overall local-regional recurrence rate of 2.8%. Ischemic complications involving the NAC were reported in 24 studies (representing 3091 mastectomies), with 9.1% of cases reported to have some degree of NAC necrosis and 2.0% of cases complicated by complete necrosis leading to NAC loss. Sixteen studies (representing 2213 mastectomies) reported rates of skin flap necrosis, which occurred in 9.5% of cases. Eighty-one percent of the total cases reviewed involved expander-implant reconstruction; in the 16 studies (representing 2343 reconstructions) that reported outcomes after expander-implant reconstruction, overall expander-implant loss was 3.4%.
There is now a significant body of literature demonstrating low rates of early local-regional recurrence and postoperative complications after TSSM. These data support the use of TSSM techniques, which improve psychological and aesthetic outcomes without compromising therapeutic efficacy.
尽管保留乳头乳晕复合体（NAC）皮肤的全乳皮肤保留乳房切除术（TSSM）具有潜在的美学和心理益处，但由于担心复发率增加或术后并发症发生率更高，人们仍然不愿使用该技术。描述TSSM术后结果的文献迅速增加，这使得对复发率和手术并发症进行全面回顾成为可能。
从MEDLINE和Cochrane数据库中识别描述保留乳头或TSSM的研究。纳入报告肿瘤学结果和/或术后并发症数据的研究。
确定了27项符合纳入标准的研究，共涉及3331例乳房切除术。对10项研究（代表1148例乳房切除术）的肿瘤学结果进行回顾，这些研究的平均/中位随访时间为2年，结果显示总体局部区域复发率为2.8%。24项研究（代表3091例乳房切除术）报告了涉及NAC的缺血性并发症，9.1%的病例报告有一定程度的NAC坏死，2.0%的病例并发完全坏死导致NAC缺失。16项研究（代表2213例乳房切除术）报告了皮瓣坏死率，发生率为9.5%。所审查的病例中81%涉及扩张器-植入物重建；在16项报告扩张器-植入物重建术后结果的研究（代表2343例重建）中，扩张器-植入物总体丢失率为3.4%。
现在有大量文献表明TSSM术后早期局部区域复发率和术后并发症发生率较低。这些数据支持使用TSSM技术，该技术可改善心理和美学结果，而不影响治疗效果。
