Washington, D.C. From the Department of Plastic and Reconstructive Surgery, Georgetown University Hospital.
Plast Reconstr Surg. 2013 Nov;132(5):1043-1054. doi: 10.1097/PRS.0b013e3182a48b8a.
Nipple-sparing mastectomy is a controversial option for breast cancer treatment due to locoregional recurrence and distant metastasis. In addition to these oncologic factors, technical factors such as ideal incision type or reconstructive options are also debatable. This systematic review examines current trends with nipple-sparing mastectomy, including selection criteria, locoregional and distant metastasis rates, incision choice, and reconstructive options.
Systematic electronic searches were performed in the PubMed and Ovid databases using search terms for studies reporting outcomes following nipple-sparing mastectomy and all forms of reconstruction. Studies between 1970 and 2013 were reviewed. Pooled descriptive statistics with separate analyses for incision type and reconstructive method were performed.
Forty-eight studies met inclusion criteria, yielding 6615 nipple-sparing mastectomies for analysis. The overall pooled complication rate was 22 percent, the nipple necrosis rate was 7 percent, the locoregional recurrence rate was 1.8 percent, and the distant metastasis rate was 2.2 percent. Comparing combined patient cohorts for two-stage expander to implant, one-stage direct to implant, and autologous reconstruction demonstrated overall complication rates of 52.8, 16.7, and 23.7 percent and nipple necrosis rates of 4.5, 4.1, and 17.3 percent, respectively. Incision types were divided into five categories: radial, periareolar/circumareolar, inframammary, mastopexy, and transareolar, with nipple necrosis rates of 8.83, 17.81, 9.09, 4.76, and 81.82 percent, respectively
Nipple-sparing mastectomy appears to be an oncologically safe option for properly selected patients, with low rates of locoregional and distant metastasis. Overall complication and nipple necrosis rates are affected by incision location and reconstruction method. Randomized controlled trials are warranted to determine best incision and reconstructive methods.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
保乳乳头切除术是一种有争议的乳腺癌治疗方法，因为它存在局部区域复发和远处转移的风险。除了这些肿瘤学因素外，技术因素，如理想的切口类型或重建选择，也是有争议的。本系统回顾检查了保乳乳头切除术的当前趋势，包括选择标准、局部区域和远处转移率、切口选择和重建选择。
在 PubMed 和 Ovid 数据库中进行了系统的电子搜索，使用了报告保乳乳头切除术和所有形式的重建术后结果的研究的搜索词。审查了 1970 年至 2013 年的研究。对切口类型和重建方法分别进行了汇总描述性统计分析。
48 项研究符合纳入标准，共分析了 6615 例保乳乳头切除术。总的合并并发症发生率为 22%，乳头坏死率为 7%，局部区域复发率为 1.8%，远处转移率为 2.2%。比较两阶段扩张器到植入物、一期直接到植入物和自体重建的联合患者队列，总的并发症发生率分别为 52.8%、16.7%和 23.7%，乳头坏死发生率分别为 4.5%、4.1%和 17.3%。切口类型分为五类：放射状、乳晕/乳晕周围、乳晕下、乳房下垂和经乳晕，乳头坏死率分别为 8.83%、17.81%、9.09%、4.76%和 81.82%。
保乳乳头切除术似乎是一种肿瘤学上安全的选择，适用于适当选择的患者，局部区域和远处转移率较低。总体并发症和乳头坏死率受切口位置和重建方法的影响。需要进行随机对照试验来确定最佳的切口和重建方法。
临床问题/证据水平：治疗，IV。
