Washington, D.C. From the Department of Plastic Surgery, Georgetown University Hospital.
Plast Reconstr Surg. 2014 May;133(5):605e-614e. doi: 10.1097/PRS.0000000000000098.
Although it is well established that reconstruction of the irradiated breast is associated with diminished cosmetic results and more frequent complications, little is known about the specific effects of radiation therapy on the reconstructive outcomes after nipple-sparing mastectomy.
Patients who had nipple-sparing mastectomy and had either previous radiation therapy for breast-conservation therapy or postmastectomy radiation therapy were reviewed. Patient demographics, reconstructive details, and postoperative outcomes were analyzed. Patient photographs were used to evaluate aesthetic parameters. Fisher's exact and t tests were used for comparison of groups, with a value of p < 0.05 considered significant.
Eighteen patients were identified as having nipple-sparing mastectomy either after breast-conservation therapy (72.2 percent) or before postmastectomy radiation therapy (27.8 percent), with an average follow-up of 3 years. First-stage complications occurred in six patients (33.3 percent). Nipple position was classified as high-riding in 55.6 percent of patients. Average time to revision was 13.3 months. Most common revisions were for correction of malposition (27.8 percent), capsular contracture (16.7 percent), and high-riding nipple (22.4 percent). Capsular contracture occurred more commonly in patients who needed postmastectomy radiation therapy compared with those who had previously undergone breast-conservation therapy (40 percent versus 7.8 percent). Maintenance of reconstruction occurred in 88.9 percent patients, with eventual implant loss occurring in two patients (11.1 percent).
Nipple-sparing mastectomy and implant reconstruction should be approached cautiously in the setting of radiation therapy. When early complications are present, significant morbidity may occur. Late revision surgery is common in this subset of patients. Implant malposition and a high-riding nipple occur most frequently.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
虽然已经证实，乳房重建与美容效果降低和更频繁的并发症有关，但对于保乳治疗或乳房切除术后放疗对乳头保留乳房切除术重建结果的具体影响知之甚少。
回顾了接受乳头保留乳房切除术且既往有保乳治疗放疗或乳房切除术后放疗的患者。分析了患者的人口统计学资料、重建细节和术后结果。使用患者照片评估美学参数。使用 Fisher 精确检验和 t 检验比较组间差异，p 值<0.05 认为有统计学意义。
18 例患者被确定为接受过乳头保留乳房切除术，分别为保乳治疗后（72.2%）或乳房切除术后放疗前（27.8%），平均随访 3 年。6 例（33.3%）患者发生一期并发症。55.6%的患者乳头位置为高位。平均修复时间为 13.3 个月。最常见的修复术式为矫正位置不良（27.8%）、包膜挛缩（16.7%）和高位乳头（22.4%）。需要乳房切除术后放疗的患者发生包膜挛缩的比例高于曾接受保乳治疗的患者（40%比 7.8%）。88.9%的患者维持重建，2 例（11.1%）最终发生假体丢失。
在放疗的情况下，应谨慎行乳头保留乳房切除术和假体重建。当早期出现并发症时，可能会出现严重的发病率。这部分患者中晚期修复手术很常见。假体位置不良和高位乳头最为常见。
临床问题/证据水平：治疗性，III 级。
