Karian Laurel S, Therattil Paul J, Wey Philip D, Nini Kevin T
Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.
Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.
J Plast Reconstr Aesthet Surg. 2017 Feb;70(2):236-242. doi: 10.1016/j.bjps.2016.11.012. Epub 2016 Nov 29.
Rare but serious complications of nipple-sparing mastectomy (NSM) include necrosis of the nipple-areolar complex (NAC) and mastectomy skin flaps. NAC and mastectomy flap delay procedures are novel techniques designed to avoid these complications and may be combined with retroareolar biopsy as a first-stage procedure. We performed a systematic review of the literature to evaluate various techniques for NAC and mastectomy flap delay.
PubMed and Cochrane databases were searched from January 1975 through April 15, 2016. The following search terms were used for both titles and key words: 'nipple sparing mastectomy' AND ('delay' OR 'stage' OR 'staged'). Two independent reviewers determined the study eligibility, only accepting studies involving patients who underwent a delay procedure prior to NSM and studies with objective results including specific outcomes of NAC and mastectomy flap necrosis.
The literature search yielded 242 studies, of which five studies met the inclusion criteria, with a total of 101 patients. Various techniques for NSM delay have been described, all of which involve undermining the nipple and surrounding mastectomy skin to some degree. Partial NAC necrosis was reported in a total of 9 patients (8.9%). Mastectomy flap necrosis was reported in a total of 8 patients (7.9%). Three of five studies reported positive retroareolar biopsy findings in a total of 7 patients (6.9%).
Delay procedures for NSM have a good safety profile and may be considered in patients at risk for NAC or mastectomy flap necrosis, such as patients with pre-existing breast scars, active smoking, prior radiation, or ptosis. These procedures have the added benefit of allowing a retroareolar biopsy to be sent for permanent sections prior to mastectomy, allowing the surgical team to plan for the removal of the NAC at the time of mastectomy if indicated and eliminating the risk of a false-negative result on frozen section analysis.
保乳手术（NSM）虽罕见但严重的并发症包括乳头乳晕复合体（NAC）坏死和乳房切除皮瓣坏死。NAC和乳房切除皮瓣延迟手术是旨在避免这些并发症的新技术，并且可作为第一阶段手术与乳晕后活检联合进行。我们对文献进行了系统回顾，以评估NAC和乳房切除皮瓣延迟的各种技术。
检索1975年1月至2016年4月15日的PubMed和Cochrane数据库。标题和关键词均使用以下检索词：“保乳手术”以及（“延迟”或“分期”或“分阶段”）。两名独立评审员确定研究的合格性，仅纳入涉及在NSM之前接受延迟手术的患者的研究以及具有客观结果（包括NAC和乳房切除皮瓣坏死的具体结果）的研究。
文献检索得到242项研究，其中5项研究符合纳入标准，共101例患者。已描述了NSM延迟的各种技术，所有这些技术均在一定程度上涉及分离乳头和周围的乳房切除皮肤。总共9例患者（8.9%）报告了部分NAC坏死。总共8例患者（7.9%）报告了乳房切除皮瓣坏死。五项研究中的三项报告了总共7例患者（6.9%）乳晕后活检结果为阳性。
NSM延迟手术具有良好的安全性，对于有NAC或乳房切除皮瓣坏死风险的患者（如既往有乳房瘢痕、当前吸烟、既往接受过放疗或乳房下垂的患者）可考虑采用。这些手术的额外好处是在乳房切除术前可将乳晕后活检标本送去做永久切片，若有指征，可让手术团队在乳房切除时计划切除NAC，并消除冰冻切片分析出现假阴性结果的风险。
