Breast Unit, Department of Surgery, San Giovanni-Addolorata Hospital, Rome, Italy.
J Surg Oncol. 2013 Sep;108(4):207-12. doi: 10.1002/jso.23390. Epub 2013 Aug 1.
Nipple-sparing mastectomy (NSM) improves cosmetic results after mastectomy. As most consider advanced tumors, or tumors near the nipple-areola complex (NAC), as a contraindication for this type of surgery, we challenged this hypothesis.
One hundred thirty-eight NSM were performed in 121 consecutive patients. In 122 procedures for cancer, patients were included if there was no evidence of NAC proximity (<1 cm), and if the retro-areolar margin was negative, even for locally advanced tumors or after neoadjuvant chemotherapy.
Total NAC necrosis occurred in six cases (4.3%). Additionally, NAC was removed after histological exam of the retro-areolar tissue in 19 cases (16% of cancer patients). Among 93 cases whose tumor-to-NAC distance was recorded, NAC was removed in 11/31 cases (35%) if the distance was 1 cm, and in 8/62 cases (12.9%) if it was more than 1 cm (P = 0.01). NAC was removed more frequently in the first half of the study (17/69 vs. 8/69: P = 0.05). At a median follow-up of 26 months for the cancer patient group, there was only one local recurrence (outside the NAC).
Our experience adds evidence that NSM is safe, if the retro-areolar resection margin is clear and maximal surgical clearance is performed.
保留乳头的乳房切除术（NSM）可改善乳房切除术后的美容效果。由于大多数人认为，对于靠近乳头乳晕复合体（NAC）的晚期肿瘤或肿瘤，NSM 是一种禁忌，因此我们对这一假设提出了挑战。
121 例连续患者中进行了 138 例 NSM。在 122 例癌症手术中，如果没有 NAC 附近（<1cm）的证据，并且即使对于局部晚期肿瘤或新辅助化疗后，乳晕后缘为阴性，则将患者纳入手术范围。
六例（4.3%）发生了全 NAC 坏死。此外，在乳晕后组织的组织学检查中，有 19 例（癌症患者的 16%）切除了 NAC。在记录肿瘤至 NAC 距离的 93 例患者中，如果距离为 1cm，则有 11/31 例（35%）切除 NAC，如果距离大于 1cm，则有 8/62 例（12.9%）切除 NAC（P=0.01）。在前半部分研究中，NAC 切除的频率更高（17/69 例与 8/69 例：P=0.05）。在癌症患者组的中位随访 26 个月时，仅发生 1 例局部复发（NAC 外）。
我们的经验进一步证明，如果乳晕后切除边缘清晰并进行最大程度的手术切除，则 NSM 是安全的。
