Division of Plastic Surgery, Hospital Sírio-Libanês, Rua Mato Grosso 306 cj.1705-1706, São Paulo, SP, 01239-040, Brazil.
Breast Cancer Res Treat. 2013 Aug;140(3):545-55. doi: 10.1007/s10549-013-2634-7. Epub 2013 Jul 30.
Nipple-sparing mastectomy (NSM) is increasingly offered to women for therapeutic and prophylactic indications. Although, clinical series have been described, there are few studies describing risk factors for complications. The objective of this study is to evaluate the incidence of complications in a series of consecutive patients submitted to NSM and differences between clinical risk factors, breast volume, and different incision types. In a cohort-designed study, 158 reconstructed patients (invasive/in situ cancer and high risk for cancer) were stratified into groups based on different types of incision used (hemi-periareolar, double-circle periareolar, and Wise-pattern). They were matched for age, body mass index, associated clinical diseases, smoking, and weight of specimen. Also included were patients treated with adjuvant chemotherapy and postoperative radiotherapy. Mean follow-up was 65.6 months. In 106 (67 %) patients, NSM was performed for breast cancer treatment and in 52 (32.9 %) for cancer prophylaxis. Thirty-nine (24.6 %) patients were submitted to hemi-periareolar technique, 67 (42.4 %) to double-circle periareolar incision, and 52 (33 %) to Wise-pattern incision. The reconstruction was performed with tissue expander and implant-expander. Local recurrence rate was 3.7 % and the incidence of distant metastases was 1.8 %. Obese patients and higher weight of specimen had a higher risk for complications. After adjusting risk factors (BMI, weight of specimen), the complications were higher for patients submitted to hemi-periareolar and Wise-pattern incisions. This follow-up survey demonstrates that NSM facilitates optimal breast reconstruction by preserving the majority of the breast skin. Selected patients can have safe outcomes and therefore this may be a feasible option for breast cancer management. Success depends on coordinated planning with the oncologic surgeon and careful preoperative and intraoperative management. Surgical risk factors include incision type, obesity, and weight of breast specimen.
保留乳头的乳房切除术（NSM）越来越多地被用于治疗和预防目的。尽管已经描述了临床系列，但很少有研究描述并发症的危险因素。本研究的目的是评估一系列连续接受 NSM 的患者的并发症发生率，并比较不同临床危险因素、乳房体积和不同切口类型之间的差异。在一项队列设计研究中，根据使用的不同切口类型（半乳晕、双圆乳晕和 Wise 型）将 158 例接受重建的患者（浸润性/原位癌和癌症高危患者）分为组。这些患者的年龄、体重指数、合并的临床疾病、吸烟和标本重量相匹配。还包括接受辅助化疗和术后放疗的患者。平均随访时间为 65.6 个月。在 106 例（67%）患者中，NSM 是为乳腺癌治疗而进行的，在 52 例（32.9%）患者中是为癌症预防而进行的。39 例（24.6%）患者接受半乳晕技术，67 例（42.4%）接受双圆乳晕切口，52 例（33%）接受 Wise 型切口。重建采用组织扩张器和植入物扩张器。局部复发率为 3.7%，远处转移发生率为 1.8%。肥胖患者和标本重量较高的患者发生并发症的风险较高。在调整了危险因素（BMI、标本重量）后，接受半乳晕和 Wise 型切口的患者并发症发生率更高。本随访调查表明，NSM 通过保留大部分乳房皮肤，为最佳乳房重建提供了便利。选择合适的患者可以获得安全的结果，因此这可能是乳腺癌管理的可行选择。手术成功取决于与肿瘤外科医生的协调规划以及仔细的术前和术中管理。手术危险因素包括切口类型、肥胖和乳房标本重量。
