Rossi Camilla, Mingozzi Matteo, Curcio Annalisa, Buggi Federico, Folli Secondo
Breast Surgery Unit, G.B. Morgagni-Pierantoni Hospital, AUSL della Romagna sede di Forlì (FC), Via Carlo Forlanini, 34. 47100 Forlì, Italy.
Gland Surg. 2015 Dec;4(6):528-40. doi: 10.3978/j.issn.2227-684X.2015.04.12.
Breast conservative therapy (BCT) is established as a safe option for most women with early breast cancer (BC). The best conservative mastectomy that can be performed, when mastectomy is unavoidable, is nipple-areola-complex sparing mastectomy (NSM), which allows the complete glandular dissection preserving the skin envelope and the nipple areola complex. In the treatment of BC, the cosmetic outcomes have become fundamental goals, as well as oncologic control. NSM is nowadays considered an alternative technique to improve the overall quality of life for women allowing excellent cosmetic results because it provides a natural appearing breast. The breast surgeon must pay attention to details and skin incision must be planned to minimize vascular impairment to the skin and the nipple. Preservation of the blood supply to the nipple is one of the most important concern during NSM because nipple or areolar necrosis is a well-described complication of this surgery. Another issue associated with the nipple preservation and the surgical technique is oncological safety related to nipple-areola-complex (NAC) involvement in patients with invasive BC. The authors present their experience on 252 NSM performed in the Breast Surgery Unit in Forlì. Careful selection of patients for this surgical procedure is imperative and many patients are not ideal candidates for this procedure because of concerns about nipple-areolar viability as women with significant large/ptotic breast, pre-existing breast scars and history of active cigarette smoking. To extend the benefits of nipple preservation to patients who are perceived to be at higher risk for nipple necrosis the authors describe technical modifications of NSM to allow nipple preservation and obtain good cosmetic outcomes.
对于大多数早期乳腺癌（BC）患者而言，保乳治疗（BCT）已被确立为一种安全的选择。在不可避免需要进行乳房切除术时，所能实施的最佳保乳乳房切除术是保留乳头乳晕复合体的乳房切除术（NSM），该手术能够在保留皮肤包膜和乳头乳晕复合体的情况下进行完整的腺体切除。在乳腺癌的治疗中，美容效果已成为与肿瘤控制同样重要的基本目标。如今，NSM被视为一种可改善女性整体生活质量的替代技术，因为它能带来极佳的美容效果，使乳房外观自然。乳腺外科医生必须注重细节，皮肤切口的设计应尽量减少对皮肤和乳头的血管损伤。在NSM过程中，保留乳头的血供是最重要的关注点之一，因为乳头或乳晕坏死是该手术中一种常见的并发症。与乳头保留及手术技术相关的另一个问题是，对于浸润性乳腺癌患者，乳头乳晕复合体（NAC）受累所涉及的肿瘤学安全性。本文作者介绍了在弗利乳腺外科进行的252例NSM手术的经验。对于该手术程序，仔细挑选患者至关重要，由于存在乳头乳晕存活问题，许多患者并非该手术的理想候选人，比如乳房显著肥大/下垂的女性、既往有乳房瘢痕的女性以及有长期吸烟史的女性。为了将乳头保留的益处扩展到那些被认为乳头坏死风险较高的患者，作者描述了NSM的技术改良方法，以实现乳头保留并获得良好的美容效果。
