San Francisco, Calif. From the Division of Plastic and Reconstructive Surgery, and the Division of Surgical Oncology, University of California, San Francisco.
Plast Reconstr Surg. 2014 Jul;134(1):1-9. doi: 10.1097/PRS.0000000000000293.
Preservation of the nipple-areolar complex with total skin-sparing mastectomy is becoming a popular mastectomy technique. As experience increases, the patient inclusion criteria for total skin sparing mastectomy expand. The authors assessed outcomes of total skin-sparing mastectomy and immediate prosthetic reconstruction in women with a prior history of augmentation mammaplasty.
Between 2005 and 2012, all women with a history of augmentation mammaplasty and implants in place, undergoing total skin-sparing mastectomy and immediate prosthetic reconstruction, were prospectively tracked. Patient demographics, expander coverage type, adjuvant treatment, and incidence of complications were analyzed. Outcomes in these patients were compared with those of patients undergoing the same operation, without prior augmentation history.
Thirty-four women with prior augmentation underwent total skin-sparing mastectomy and immediate tissue expander placement on 51 breasts. Comparison to the nonaugmentation group showed similar rates of superficial nipple necrosis (0 percent, p=0.324), complete nipple necrosis (0 percent, p=0.324), and skin flap necrosis (4 percent, p=1.0). The prior augmentation group did have a higher rate of implant loss (10 percent, p=0.515), with all but one of these occurring in irradiated patients.
Total skin-sparing mastectomy and immediate prosthetic reconstruction is a safe technique in women with a history of augmentation mammaplasty. The preferred reconstructive technique is immediate submuscular tissue expander placement. In the setting of no radiation history, this operation carries a safety profile similar to that of patients without a history of prior augmentation, and can be offered safely.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.
保留乳头乳晕复合体的全皮瓣保留乳房切除术正成为一种流行的乳房切除术技术。随着经验的增加，全皮瓣保留乳房切除术的患者纳入标准也在扩大。作者评估了有隆胸史的女性行全皮瓣保留乳房切除术和即刻假体重建的结果。
在 2005 年至 2012 年间，所有有隆胸史且乳房内有植入物的女性，接受全皮瓣保留乳房切除术和即刻假体重建，均前瞻性地进行了跟踪。分析了患者的人口统计学资料、扩张器覆盖类型、辅助治疗和并发症发生率。将这些患者的结果与没有隆胸史的接受相同手术的患者进行比较。
34 例有隆胸史的女性在 51 个乳房上接受了全皮瓣保留乳房切除术和即刻组织扩张器放置。与非隆胸组相比，浅表乳头坏死的发生率相似（0%，p=0.324），完全乳头坏死的发生率相似（0%，p=0.324），皮肤瓣坏死的发生率也相似（4%，p=1.0）。但隆胸组的植入物丢失率较高（10%，p=0.515），除 1 例外，其余均发生在接受放疗的患者中。
有隆胸史的女性行全皮瓣保留乳房切除术和即刻假体重建是一种安全的技术。首选的重建技术是即刻胸肌下组织扩张器放置。在没有放疗史的情况下，这种手术的安全性与没有隆胸史的患者相似，可以安全地进行。
临床问题/证据水平：风险，II 级。
