Longo Benedetto, Laporta Rosaria, Sorotos Michail, Pagnoni Marco, Gentilucci Marika, Santanelli di Pompeo Fabio
Plastic Surgery Department, Sant'Andrea Hospital, School of Medicine and Psychology, "Sapienza" University of Rome, Via di Grottarossa 1035-1039, 00189, Rome, Italy.
Aesthetic Plast Surg. 2014 Dec;38(6):1101-8. doi: 10.1007/s00266-014-0406-3. Epub 2014 Oct 16.
Although autologous microvascular reconstruction following nipple-sparing mastectomy (NSM) is considered one of the best reconstructive choices, this procedure cannot be offered to all patients. The aim of this study was to define a fat grafting protocol for successful reconstruction following NSM and to assess its reliability in irradiated and non-irradiated patients.
Twenty-one patients were prospectively enrolled and stratified in Group-A (11 non-irradiated) and Group-B (10 irradiated) NSMs comparing clinical and aesthetic outcomes. A fat grafting protocol was used to standardize the procedure. Continuous and categorical variables were analysed using the Student t test and the Kruskal-Wallis test, respectively. A value of p ≤ 0.05 was considered statistically significant.
The groups were homogeneous in terms of demographics (p > 0.05), while number of sessions, mean volume of the first two treatments, and overall injected volume showed significant differences (p < 0.001; p < 0.001; p = 0.002). Volume, shape, position of the breast mound, IMF and scar location subscales obtained high score evaluations without a significant difference between the groups (p > 0.05), whereas the skin texture subscale showed a lower score evaluation in Group-B than in Group-A (p = 0.001). Although a significant difference for total subscales was in favour of Group-A (p = 0.001), the global score had a high rate evaluation in both groups (p = 0.132). Inter-rater reliability showed substantial agreement among all categories, total and global scores.
To the best of our knowledge, this is the first prospective series of fat transfer reconstructions following NSM using a systematic approach. Although further studies are required, it may be considered an effective option whenever flap reconstruction cannot be performed.
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尽管保留乳头的乳房切除术（NSM）后的自体微血管重建被认为是最佳重建选择之一，但该手术并非适用于所有患者。本研究的目的是确定一种用于NSM后成功重建的脂肪移植方案，并评估其在接受放疗和未接受放疗患者中的可靠性。
前瞻性纳入21例患者，分为A组（11例未接受放疗）和B组（10例接受放疗）的NSM患者，比较临床和美学效果。采用脂肪移植方案使手术标准化。连续变量和分类变量分别采用Student t检验和Kruskal-Wallis检验进行分析。p≤0.05被认为具有统计学意义。
两组在人口统计学方面具有同质性（p>0.05），而治疗次数、前两次治疗的平均体积和总体注射体积存在显著差异（p<0.001；p<0.001；p = 0.002）。乳房隆起的体积、形状、位置、乳房下皱襞和瘢痕位置亚量表获得高分评价，两组之间无显著差异（p>0.05），而皮肤质地亚量表在B组中的评分低于A组（p = 0.001）。尽管总分量表的显著差异有利于A组（p = 0.001），但两组的总体评分均具有较高的评价率（p = 0.132）。评分者间信度显示所有类别、总分和总体评分之间具有高度一致性。
据我们所知，这是首个采用系统方法进行NSM后脂肪移植重建的前瞻性系列研究。尽管需要进一步研究，但在无法进行皮瓣重建时，它可能被视为一种有效的选择。
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