Department of Surgery, School of Medicine, Faculty of Health Science, University of Pretoria, Private Bag X323, Arcadia, Pretoria 0007, South Africa.
Section of Histology, Cell Biology and Embryology, Department of Anatomy, Faculty of Health Sciences, University of Pretoria, South Africa.
Int J Surg. 2014;12(5):384-9. doi: 10.1016/j.ijsu.2014.03.012. Epub 2014 Mar 21.
Resectional breast surgery has become less extensive. Dissection on plane of the superficial fascia covering the breast (juxtacapsular) is used during various procedures for retention of the appearance of the breast. The accuracy of this method and its ability to remove all glandular breast tissue has never been tested.
Twenty patients with breast cancer were studied prospectively. Juxtacapsular dissection of the inferior flap was performed during mastectomy. Biopsies were taken on each side of the dissection plane at 3 sites: median, medial and lateral. Several histological slides were prepared from each biopsy and examined for the presence of breast parenchymal or dispersed glandular tissue.
Three hundred and forty nine histological slides were examined, 185 from the resected breast side and 164 from the subcutaneous side. Ninety four percent of the slides from the breast side contained glandular tissue. Breast glandular tissue was found outside the dissection plane in 16 of 20 cases and in 33% of slides. This was sparse and dispersed in 69% of slides. A mean of 81% of slides from individual cases revealed glandular tissue inside and the absence of glandular tissue outside the dissection plane ("expected result"), demonstrating predominantly accurate juxtacapsular dissection.
This study demonstrated that accurate juxtacapsular inferior flap dissection leaves behind glandular breast tissue in a greater proportion of cases than any previous study. While this tissue is sparsely-distributed, surgeons should be aware of the occurrence of glandular breast tissue outside the juxtacapsular dissection plane in the majority of cases.
切除性乳房手术的范围已经缩小。在各种保留乳房外观的手术中，通常在覆盖乳房的浅筋膜（囊外）平面上进行解剖。这种方法的准确性及其去除所有乳腺组织的能力从未经过测试。
前瞻性地研究了 20 例乳腺癌患者。在乳房切除术期间对下皮瓣进行囊外解剖。在解剖平面的每侧 3 个部位（中央、内侧和外侧）进行活检。从每个活检部位制备多个组织学切片，并检查是否存在乳腺实质或分散的腺组织。
共检查了 349 个组织学切片，其中 185 个来自切除的乳房侧，164 个来自皮下侧。94%的乳房侧切片含有腺组织。在 20 例中有 16 例在囊外平面之外发现乳腺腺组织，在 33%的切片中发现。69%的切片中这种组织稀疏且分散。在个体病例中，81%的切片显示囊外平面内有腺组织而无腺组织，表明囊外解剖主要是准确的。
本研究表明，与以往任何研究相比，准确的囊外下皮瓣解剖在更大比例的病例中留下了乳腺腺组织。尽管这些组织分布稀疏，但外科医生应该意识到在大多数情况下，在囊外解剖平面之外会发生乳腺腺组织。
