Becker Hilton, Billington Mary Ellen
Florida Atlantic University College of Medicine, Boca Raton, Fla.
Plast Reconstr Surg Glob Open. 2014 Dec 5;2(11):e253. doi: 10.1097/GOX.0000000000000189. eCollection 2014 Nov.
Nipple-sparing mastectomy (NSM) is gaining acceptance as an oncologically sound and cosmetically superior mastectomy technique. Debate exists over the management of positive margins near the nipple-areola complex. This case report presents a novel approach to the management of margin-positive ductal carcinoma in situ in NSM. A 50-year-old white female with invasive ductal carcinoma underwent NSM. Intraoperative pathology indicated the presence of DCIS-positive retroareolar margins. Revision through a direct vertical nipple incision allowed for adequate surgical revision and pathologic evaluation of the retroareolar breast tissue while maintaining the nipple-areola skin and primary mastectomy incision. This novel approach ensures negative margins, allows superior cosmetic outcome, and improves patient autonomy in decision making. The technique may translate to NSM patients with positive retroareolar margins or false-negative margins.
保留乳头的乳房切除术（NSM）作为一种肿瘤学上合理且美容效果更佳的乳房切除技术正逐渐被接受。关于乳头乳晕复合体附近切缘阳性的处理存在争议。本病例报告介绍了一种处理NSM中切缘阳性导管原位癌的新方法。一名50岁患有浸润性导管癌的白人女性接受了NSM。术中病理显示乳晕后切缘存在导管原位癌阳性。通过直接垂直乳头切口进行修复，既能对乳晕后乳腺组织进行充分的手术修复和病理评估，又能保留乳头乳晕皮肤和初次乳房切除切口。这种新方法确保切缘阴性，能获得更好的美容效果，并提高患者决策的自主性。该技术可能适用于乳晕后切缘阳性或假阴性的NSM患者。
