Chirappapha Prakasit, Petit Jean-Yves, Rietjens Mario, De Lorenzi Francesca, Garusi Cristina, Martella Stefano, Barbieri Benedetta, Gottardi Alessandra, Andrea Manconi, Giuseppe Lomeo, Hamza Alaa, Lohsiriwat Visnu
Department of Plastic and Reconstructive Surgery, European Institute of Oncology, Milan, Italy; and Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University Bangkok, Thailand.
Plast Reconstr Surg Glob Open. 2014 Feb 7;2(1):e99. doi: 10.1097/GOX.0000000000000038. eCollection 2014 Jan.
Nipple sparing mastectomy (NSM) can be performed for prophylactic mastectomy and the treatment of selected breast cancer with oncologic safety. The risk of skin and nipple necrosis is a frequent complication of NSM procedure, and it is usually related to surgical technique. However, the role of the breast morphology should be also investigated.
We prospectively performed an analysis of 124 NSM from September 2012 to January 2013 at the European Institute of Oncology, Milan, Italy, focusing on necrotic complications. We analyzed the association between the risks of skin necrosis and the breast morphology of the patients.
Among 124 NSM in 113 patients, NSM procedures were associated with necrosis in 22 mastectomies (17.7%) among which included partial necrosis of nipple-areolar complex (NAC) in 15 of 124 NSM (12.1%) and total necrosis in 4 cases (3.5%). The NAC was removed in 5 NSM cases (4%). The volume of breast removed was the only significant factor increasing the risk of skin necrosis. The degree of ptosis was not significantly related to the necrosis risk.
Large glandular specimen increases the risk of NAC necrosis. The degree of ptosis and the distance between the sternal notch and the NAC have no significant impact on necrotic complications in NSM. To reduce the necrotic complications in large breast after NSM, reconstruction should better be performed with autologous flap or slow skin expansion using the expander technique.
保乳全乳切除术（NSM）可用于预防性乳房切除术以及部分乳腺癌的治疗，且具有肿瘤学安全性。皮肤和乳头坏死风险是NSM手术常见的并发症，通常与手术技术有关。然而，乳房形态的作用也应予以研究。
我们前瞻性地分析了2012年9月至2013年1月在意大利米兰欧洲肿瘤研究所进行的124例NSM手术，重点关注坏死并发症。我们分析了皮肤坏死风险与患者乳房形态之间的关联。
在113例患者的124例NSM手术中，22例乳房切除术（17.7%）出现坏死并发症，其中包括124例NSM手术中有15例（12.1%）乳头乳晕复合体（NAC）部分坏死，4例（3.5%）完全坏死。5例NSM手术（4%）切除了NAC。切除乳房的体积是增加皮肤坏死风险的唯一显著因素。乳房下垂程度与坏死风险无显著相关性。
大的腺体标本会增加NAC坏死的风险。乳房下垂程度以及胸骨切迹与NAC之间的距离对NSM手术中的坏死并发症无显著影响。为减少NSM术后大乳房的坏死并发症，最好采用自体皮瓣或使用扩张器技术进行缓慢皮肤扩张来进行重建。
