Salibian Arthur H, Harness Jay K, Mowlds Donald S
From the *St. Joseph Hospital; †Aesthetic and Plastic Surgery Institute, and ‡Department of Surgery, UC Irvine Medical Center Orange, CA.
Ann Plast Surg. 2016 Oct;77(4):388-95. doi: 10.1097/SAP.0000000000000611.
Patients undergoing nipple-sparing mastectomy and immediate-implant based reconstruction occasionally require a mastopexy based on their breast size and degree of ptosis. Previous reports have shown the feasibility of mastopexy-nipple-sparing mastectomy in selected patients to raise the nipple up to 5 cm. Major mastopexy with nipple transposition more than 6 cm in conjunction with nipple-sparing mastectomy for therapeutic indications has not been described. The authors review their experience with primary buttonhole mastopexy performed in conjunction with nipple-sparing mastectomy.
Between 2008 and 2014, 16 patients (32 breasts) underwent bilateral primary mastopexy and nipple-sparing mastectomy with immediate staged implant-based reconstruction. The Passot buttonhole technique was used for the mastopexy in all patients, raising the nipple from 7 to 12 cm. Tumor-related data, risk factors, breast size, degree of ptosis, expander size, fill volume, selection criteria, and complications are discussed.
The average follow-up period was 33 months (range, 14 to 80 months). There were no tumor recurrences, and all patients completed their reconstruction. Two patients required removal of the expander and delayed reconstruction because of infection and implant exposure due to nipple-areola loss. The reasons for nipple-areola loss and technical modifications to enhance skin viability by retaining a thin layer of subareolar breast tissue for removal during the second-stage implant exchange are discussed.
Primary mastopexy using the buttonhole technique performed together with nipple-sparing mastectomy is a safe procedure with predictable results in patients with very large or ptotic breasts requiring lifts greater than 6 cm. The success of the combined procedure depends on preserving a thin layer of subareolar breast tissue and removing it at the time of implant exchange.
接受保留乳头的乳房切除术及即刻植入式乳房重建术的患者，有时会因其乳房大小和下垂程度而需要进行乳房上提术。既往报道显示，在部分患者中，乳房上提术联合保留乳头的乳房切除术可将乳头提升高达5厘米。尚未有关于为治疗目的而进行的乳头移位超过6厘米的大型乳房上提术联合保留乳头的乳房切除术的描述。作者回顾了他们在联合保留乳头的乳房切除术进行一期纽扣孔乳房上提术方面的经验。
2008年至2014年期间，16例患者（32侧乳房）接受了双侧一期乳房上提术及保留乳头的乳房切除术，并进行了即刻分期植入式乳房重建。所有患者均采用帕索纽扣孔技术进行乳房上提术，将乳头提升7至12厘米。讨论了肿瘤相关数据、危险因素、乳房大小、下垂程度、扩张器大小、填充量、选择标准及并发症。
平均随访期为33个月（范围14至80个月）。无肿瘤复发，所有患者均完成了乳房重建。2例患者因感染及乳头乳晕缺失导致植入物外露，需要取出扩张器并延迟重建。讨论了乳头乳晕缺失的原因以及在二期植入物置换时通过保留乳晕下一层薄的乳腺组织以提高皮肤活力的技术改良。
对于乳房非常大或下垂且需要提升超过6厘米的患者，采用纽扣孔技术进行的一期乳房上提术联合保留乳头的乳房切除术是一种安全的手术，效果可预测。联合手术的成功取决于保留乳晕下一层薄的乳腺组织并在植入物置换时将其切除。
