Benson John R, Dumitru Dorin, Malata Charles M
1 Cambridge Breast Unit, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK ; 2 Faculty of Medical Science, Anglia Ruskin University, Cambridge and Chelmsford, CM1 1SQ, UK.
Gland Surg. 2016 Feb;5(1):37-46. doi: 10.3978/j.issn.2227-684X.2015.05.13.
Conservative mastectomy is a form of nipple-sparing mastectomy which is emerging as a surgical option for selected breast cancer patients. This technique differs from subcutaneous mastectomy which is well established as a technique for risk reduction but leaves behind a finite remnant of retro-areolar breast tissue. Clinical trials have confirmed the efficacy and safety of breast conservation therapy for smaller localised breast tumors whereby a variable amount of surrounding normal tissue is excised with administration of breast radiotherapy post-operatively. Conservative mastectomy aims to remove all breast tissue with dissection continued into the core of the nipple. However, the indication for conservative mastectomy remains to be defined but generally includes tumors of modest size located at least 2 cm away from the nipple. Patients undergoing conservative mastectomy do not necessarily receive adjuvant radiotherapy and this may only be intra-operative irradiation of the nipple-areola complex (NAC). Preservation of the NAC as part of a skin-sparing mastectomy in patients who might otherwise require standard mastectomy is of unproven safety from an oncologic perspective but is associated with enhanced cosmetic outcomes and quality-of-life. The advent of conservative mastectomy has coincided with a trend for "maximal surgery" with bilateral extirpation of all breast tissue in conjunction with immediate breast reconstruction. It is essential there is no compromise of local recurrence and survival in terms of ipsilateral breast cancer treatment. Further studies are required to clarify the indications for conservative mastectomy and confirm oncologic equivalence to either wide local excision and breast irradiation or conventional/skin-sparing mastectomy with sacrifice of the nipple areola complex.
保乳根治术是一种保留乳头的乳房切除术，正逐渐成为特定乳腺癌患者的手术选择。该技术不同于皮下乳房切除术，皮下乳房切除术作为一种降低风险的技术已被广泛应用，但会残留乳晕后有限的乳腺组织。临床试验已证实保乳治疗对较小的局限性乳腺肿瘤的有效性和安全性，即术后通过放疗切除不同量的周围正常组织。保乳根治术旨在切除所有乳腺组织，并将解剖范围延伸至乳头核心。然而，保乳根治术的适应症仍有待确定，但一般包括位于距乳头至少2厘米处的中等大小肿瘤。接受保乳根治术的患者不一定接受辅助放疗，可能仅在术中对乳头乳晕复合体（NAC）进行照射。对于可能需要标准乳房切除术的患者，将保留NAC作为保皮乳房切除术的一部分，从肿瘤学角度来看，其安全性尚未得到证实，但与改善美容效果和生活质量相关。保乳根治术的出现与“最大程度手术”的趋势相吻合，即双侧切除所有乳腺组织并立即进行乳房重建。在同侧乳腺癌治疗方面，确保局部复发和生存率不受影响至关重要。需要进一步研究以明确保乳根治术的适应症，并确认其在肿瘤学上与广泛局部切除加乳房放疗或牺牲乳头乳晕复合体的传统/保皮乳房切除术等效。
