Division of Surgical Oncology, Department of General Surgery, Cleveland Clinic, Cleveland, OH.
Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH.
Clin Breast Cancer. 2017 Nov;17(7):572-577. doi: 10.1016/j.clbc.2017.04.003. Epub 2017 Apr 12.
Nipple-sparing mastectomy (NSM) is a prevalent operation for patients with breast cancer. Indications have been limited to tumors accessible via radial, infra-mammary, or periareolar incisions out of concern for oncologic and technical safety. We study an alternative approach to NSM based on tumor ultrasound-guided incisions (TUGI) and report its oncologic and technical outcomes.
A retrospective chart review examined patients who underwent TUGI NSM between 2013 and 2016. Operative notes, postoperative notes, pathology reports, and postoperative photography were analyzed.
Ninety-four patients had mastectomy with reconstruction performed over a 3-year period by the senior authors. Of those, 31 (33%) were NSM and 13 (14%) had the TUGI technique, forming the study group. The median tumor size was 1.5 cm, with a median distance from the nipple areolar complex of 5 cm. Sixty-two percent of the incisions were in the upper quadrants of the breast. Median operative time was 207 minutes. Zero patients had positive margins. One hundred percent of patients underwent immediate tissue expander placement, 46% with acellular dermal matrix. For final reconstruction, 23% had a free flap, 69% implant, and 8% are still pending. Eight percent of patients had wound infection, and 15% of patients had NAC necrosis. No cancer recurrence has been observed at a median follow-up of 17 months.
TUGI offers a valuable, oncologically sound alternative approach to traditional NSM. The technical results and outcomes support its use in selected patients with breast cancer undergoing NSM.
保乳头乳房切除术（NSM）是一种常用于乳腺癌患者的手术。出于对肿瘤学和技术安全性的考虑，该手术的适应证仅限于通过放射状、乳房下或乳晕周围切口可触及的肿瘤。我们研究了一种基于肿瘤超声引导切口（TUGI）的 NSM 替代方法，并报告了其肿瘤学和技术结果。
对 2013 年至 2016 年间接受 TUGI NSM 的患者进行了回顾性图表审查。分析了手术记录、术后记录、病理报告和术后照片。
在 3 年期间，高级作者对 94 例患者进行了乳房切除术和重建。其中 31 例（33%）为 NSM，13 例（14%）采用了 TUGI 技术，形成了研究组。肿瘤大小中位数为 1.5cm，距乳晕复合体中位数为 5cm。62%的切口位于乳房的上象限。中位手术时间为 207 分钟。零例患者切缘阳性。所有患者均立即放置组织扩张器，其中 46%使用脱细胞真皮基质。最终重建时，23%采用游离皮瓣，69%采用植入物，8%仍在等待中。8%的患者发生伤口感染，15%的患者发生乳头乳晕复合体坏死。在中位随访 17 个月时，未观察到癌症复发。
TUGI 为传统 NSM 提供了一种有价值的、肿瘤学上合理的替代方法。技术结果和结果支持在接受 NSM 的选定乳腺癌患者中使用该方法。
