New York, N.Y. From the Division of Plastic Surgery, Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medical College.
Plast Reconstr Surg. 2014 May;133(5):1053-1062. doi: 10.1097/PRS.0000000000000094.
This article discusses the senior author's (M.T.) experience with nipple-areola complex malposition following nipple-sparing mastectomy, surgical options for treatment, and an analysis of risk factors.
A retrospective review was conducted on a prospectively collected institutional review board-approved database of nipple-sparing mastectomy cases with immediate device-based reconstruction performed between July of 2006 and October of 2012. Malposition was graded as mild (1 cm), moderate (2 cm), or severe (>3 cm) displacement.
Three hundred nineteen nipple-sparing mastectomies were reviewed. Malposition occurred in 44 (13.79 percent). Significant factors were age (p < 0.0001), diabetes mellitus (p = 0.0025), body mass index (p = 0.0093), preoperative sternal notch-to-nipple distance (p = 0.015), preoperative breast base width (p = 0.0001), periareolar mastectomy incision with lateral extension (p < 0.0001), prior radiation (p = 0.0004), prior lumpectomy (p = 0.0125), unilateral nipple-sparing mastectomy (p = 0.0004), and postoperative nipple-areola complex ischemia (p = 0.0174). Smoking status, breast volume resected, implant size, ablative surgeon, acellular dermal matrix, and single-stage reconstruction were not significant. Nineteen patients were satisfied. Eight were not offered surgical correction because of an inadequate skin envelope. Eight had crescent mastopexy, three had implant exchange and pocket revision, four had free nipple grafts, and two had pedicled nipple transposition. There were no incidences of necrosis or malposition after surgical correction.
Nipple-sparing mastectomy followed by immediate device-based reconstruction has a risk of nipple malposition. Various surgical procedures are available to correct nipple malposition based on clinical presentation and are safe in certain populations.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
本文讨论了高级作者（M.T.）在保留乳头乳晕复合体的乳房切除术后出现乳头乳晕复合体位置不良的经验，治疗的手术选择，并对危险因素进行了分析。
对 2006 年 7 月至 2012 年 10 月间进行的即刻基于器械的重建的保留乳头乳晕复合体乳房切除术的机构审查委员会批准的前瞻性收集数据库进行了回顾性分析。位置不良分为轻度（1 厘米）、中度（2 厘米）或重度（>3 厘米）移位。
共回顾了 319 例保留乳头乳晕复合体的乳房切除术。有 44 例（13.79%）发生位置不良。显著的因素是年龄（p<0.0001）、糖尿病（p=0.0025）、体重指数（p=0.0093）、术前胸骨切迹至乳头距离（p=0.015）、术前乳房基底宽度（p=0.0001）、乳晕周围乳房切除术切口伴外侧延伸（p<0.0001）、既往放疗（p=0.0004）、既往肿块切除术（p=0.0125）、单侧保留乳头乳晕复合体乳房切除术（p=0.0004）和术后乳头乳晕复合体缺血（p=0.0174）。吸烟状况、切除的乳房体积、植入物大小、消融术者、脱细胞真皮基质和单阶段重建均无显著影响。19 例患者满意。8 例因皮肤包绕不足而未行手术矫正。8 例行新月形乳房成形术，3 例行植入物置换和口袋修正，4 例行游离乳头移植，2 例行带蒂乳头转位术。手术后矫正无坏死或位置不良的发生。
保留乳头乳晕复合体的乳房切除术后即刻基于器械的重建有乳头位置不良的风险。根据临床表现，有多种手术方法可用于矫正乳头位置不良，在某些人群中是安全的。
临床问题/证据水平：风险，III 级。
