有乳房缩小成形术或乳房上提术史的患者行保留乳头乳晕的乳房切除术：安全吗？
Nipple-sparing mastectomy in patients with a history of reduction mammaplasty or mastopexy: how safe is it?
机构信息
New York and Manhasset, N.Y.; Philadelphia, Pa.; and Houston, Texas From New York University Medical Center, North Shore-Long Island Jewish Health System, University of Pennsylvania Health System, and M. D. Anderson Cancer Center.
出版信息
Plast Reconstr Surg. 2013 May;131(5):962-967. doi: 10.1097/PRS.0b013e3182865ad2.
BACKGROUND
Nipple-sparing mastectomy has gained popularity, but the question remains of whether it can be offered safely to women with a history of reduction mammaplasty or mastopexy. The authors present their experience with nipple-sparing mastectomy in this patient population.
METHODS
Patients at the authors' institution who had reduction mammaplasty or mastopexy before nipple-sparing mastectomy were identified. Outcomes measured include nipple-areola complex viability, mastectomy flap necrosis, infection, presence of cancer in the nipple-areola complex, and breast cancer recurrence.
RESULTS
The records of the nipple-sparing mastectomy patients at the authors' institution from 2006 through 2012 were reviewed. The authors identified 13 breasts in eight patients that had nipple-sparing mastectomy following reduction mammaplasty or mastopexy. Within this subset of patients, the mean age was 46.6 years and the mean body mass index was 25.1. Nine of 13 breasts had therapeutic resections, whereas the remaining four were for prophylactic indications. Average time elapsed between reduction mammaplasty or mastopexy and nipple-sparing mastectomy was 51.8 months (range, 33 days to 11 years). In all cases, prior reduction mammaplasty/mastopexy incisions were used for nipple-sparing mastectomy. Ten breasts underwent reconstruction immediately with tissue expanders, one with a latissimus dorsi flap with immediate implant and two with immediate abdominally based free flaps. Complications included one hematoma requiring evacuation and one displaced implant requiring revision. There were no positive subareolar biopsy results, and the nipple viability was 100 percent. Mean follow-up time was 10.5 months.
CONCLUSIONS
The authors' experience demonstrates that nipple-sparing mastectomy can be offered to patients with a history of reduction mammaplasty or mastopexy with reconstructive outcomes comparable to those of nipple-sparing mastectomy alone.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
背景
保留乳头的乳房切除术已经广受欢迎，但对于有乳房缩小成形术或乳房悬吊术病史的女性，是否可以安全地进行保留乳头的乳房切除术仍存在疑问。作者介绍了他们在该患者群体中进行保留乳头的乳房切除术的经验。
方法
作者所在机构的接受过乳房缩小成形术或乳房悬吊术的患者，被确定为保留乳头的乳房切除术的对象。测量的结果包括乳头乳晕复合体的活力、乳房切除术皮瓣坏死、感染、乳头乳晕复合体中癌症的存在和乳腺癌的复发。
结果
回顾了作者所在机构 2006 年至 2012 年期间接受保留乳头的乳房切除术患者的记录。作者在 8 名患者的 13 个乳房中发现了保留乳头的乳房切除术，这些患者在接受乳房缩小成形术或乳房悬吊术之后进行了保留乳头的乳房切除术。在这组患者中，平均年龄为 46.6 岁，平均体重指数为 25.1。13 个乳房中有 9 个是为了治疗而进行的切除术，而其余 4 个是预防性的。乳房缩小成形术或乳房悬吊术与保留乳头的乳房切除术之间的平均时间间隔为 51.8 个月（范围为 33 天至 11 年）。在所有情况下，保留乳头的乳房切除术都使用了先前的乳房缩小成形术/乳房悬吊术切口。10 个乳房立即用组织扩张器进行了重建，1 个乳房用背阔肌皮瓣加立即植入物进行了重建，2 个乳房用立即腹部游离皮瓣进行了重建。并发症包括 1 例血肿需要引流，1 例移位的植入物需要修复。乳晕下活检无阳性结果，乳头活力为 100%。平均随访时间为 10.5 个月。
结论
作者的经验表明，对于有乳房缩小成形术或乳房悬吊术病史的患者，可以提供保留乳头的乳房切除术，并且重建结果与单独进行保留乳头的乳房切除术相当。
临床问题/证据水平：治疗，IV。
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