Donovan Cory A, Harit Attiya P, Chung Alice, Bao Jean, Giuliano Armando E, Amersi Farin
Division of Surgical Oncology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Ann Surg Oncol. 2016 Oct;23(10):3226-31. doi: 10.1245/s10434-016-5323-z. Epub 2016 Jun 28.
While nipple-sparing mastectomy (NSM) for the treatment of breast cancer is becoming more accepted, technical aspects are still evolving. Data regarding risk factors contributing to complications after NSM are limited. This study evaluated technical aspects on outcomes of NSM.
Review of our database identified 201 patients who had NSM during the period from January 2012 to June 2015. We compared the effect of operative techniques on surgical outcomes.
A total of 351 NSM were performed in 201 patients. Mean patient age was 47 years. Inframammary (47 %) or periareolar (35 %) incisions were most frequent. Tumescence was used in 203 (58 %) NSM. Skin flaps were created using sharp dissection in 213 (61 %) and electrocautery in 138 (39 %) breasts. Nipple areola complex (NAC) necrosis was seen in 56 (16 %) breasts, of which 7 were severe (2 %). A higher rate of NAC complications was seen with periareolar incisions (p = 0.02). Sharp dissection did not result in significant rates of flap necrosis compared with electrocautery. Ten patients (3 %) had a positive anterior/deep margin, of which 7 (64 %) had an inframammary approach. Twenty-two (11 %) patients had an infection that required intravenous antibiotics. Fourteen (7 %) patients had implant loss. Dissection technique was not associated with implant loss (p = 1.0) or infection (p = 0.84). Forty-two (12 %) patients had radiation and seven (16 %) required implant removal.
NSM has an acceptable complication rate. NAC necrosis requiring excision or implant loss is rare. Postmastectomy radiation is a significant risk factor for implant loss. Inframammary incisions have fewer ischemic complications but may result in tumor-involved margins.
虽然保留乳头的乳房切除术（NSM）在治疗乳腺癌方面越来越被接受，但其技术方面仍在不断发展。关于NSM术后并发症相关危险因素的数据有限。本研究评估了NSM手术结果的技术方面。
回顾我们的数据库，确定了2012年1月至2015年6月期间接受NSM的201例患者。我们比较了手术技术对手术结果的影响。
201例患者共进行了351例NSM。患者平均年龄为47岁。乳房下皱襞（47%）或乳晕周围（35%）切口最为常见。203例（58%）NSM使用了肿胀麻醉。213例（61%）乳房采用锐性剥离制作皮瓣，138例（39%）采用电灼法。56例（16%）乳房出现乳头乳晕复合体（NAC）坏死，其中7例严重（2%）。乳晕周围切口的NAC并发症发生率更高（p = 0.02）。与电灼法相比，锐性剥离未导致皮瓣坏死率显著升高。10例患者（3%）切缘前/深部阳性，其中7例（64%）采用乳房下入路。22例（11%）患者发生感染，需要静脉使用抗生素。14例（7%）患者出现植入物丢失。剥离技术与植入物丢失（p = 1.0）或感染（p = 0.84）无关。42例（12%）患者接受了放疗，7例（16%）需要取出植入物。
NSM的并发症发生率可接受。需要切除的NAC坏死或植入物丢失很少见。乳房切除术后放疗是植入物丢失的重要危险因素。乳房下皱襞切口缺血并发症较少，但可能导致肿瘤切缘受累。
