Bailey Christopher R, Ogbuagu Onyebuchi, Baltodano Pablo A, Simjee Usamah F, Manahan Michele A, Cooney Damon S, Jacobs Lisa K, Tsangaris Theodore N, Cooney Carisa M, Rosson Gedge D
Baltimore, Md.; Albany, N.Y.; and Philadelphia, Pa.
From the Departments of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine; the Department of Plastic Surgery, Albany Medical Center; and the Department of Surgery, Thomas Jefferson University Hospital.
Plast Reconstr Surg. 2017 Aug;140(2):219-226. doi: 10.1097/PRS.0000000000003505.
Loss of the nipple-areola complex can be psychologically and sexually devastating. Nipple-sparing mastectomy provides robust cosmetic results, but few studies have investigated the quality-of-life outcomes associated with it.
The authors performed an institutional review board-approved retrospective study of 32 patients who underwent nipple-sparing mastectomy with implant-based or autologous reconstruction and 32 control patients who underwent non-nipple-sparing mastectomy with reconstruction matched by reconstruction type and operative period. They then compared premastectomy and postreconstruction responses to the BREAST-Q, a validated and breast reconstruction-specific quality-of-life questionnaire, within and between their study and control populations.
The nipple-sparing and non-nipple-sparing mastectomy groups were statistically similar in terms of mean age [49.9 ± 8.5 years (range, 36 to 69 years) and 47.7 ± 10.3 years (range, 26 to 68 years) (p = 0.29), respectively] and mean body mass index [24.3 ± 3.5 kg/m (range, 17.9 to 33.7 kg/m) and 25.5 ± 5.4 kg/m (range, 19.2 to 39.2 kg/m) (p = 0.29), respectively]. There were no significant between-group differences in occurrence of postreconstruction complications. The authors found significantly higher mean postreconstruction scores in the nipple-sparing mastectomy group within the Satisfaction with Breasts (p = 0.039) and the Satisfaction with Outcome (p = 0.017) domains. Finally, they noted higher median postreconstruction scores in the nipple-sparing mastectomy group within the Psychosocial Well-being (p = 0.043) and Satisfaction with Breasts (p = 0.004) domains.
Psychological concerns regarding malignancy may negatively impact premastectomy patient quality of life. Reconstructive surgery improves patients' postmastectomy quality of life. Nipple-sparing mastectomy appears to provide significantly better improvement in postreconstruction quality of life, specifically in the Satisfaction with Breasts and Satisfaction with Outcome domains of the BREAST-Q, compared with non-nipple-sparing mastectomies.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
乳头乳晕复合体缺失可能会对心理和性功能造成严重损害。保留乳头的乳房切除术能带来良好的美容效果，但很少有研究调查与之相关的生活质量结果。
作者进行了一项经机构审查委员会批准的回顾性研究，研究对象为32例行保留乳头乳房切除术并采用植入物或自体组织重建的患者，以及32例对照患者，这些对照患者行不保留乳头乳房切除术并根据重建类型和手术时间进行匹配。然后，他们比较了研究组和对照组人群术前及重建后对BREAST-Q（一份经过验证的、针对乳房重建的生活质量问卷）的回答。
保留乳头和不保留乳头乳房切除术组在平均年龄方面无统计学差异[分别为49.9±8.5岁（范围36至69岁）和47.7±10.3岁（范围26至68岁）（p = 0.29）]，平均体重指数也无统计学差异[分别为24.3±3.5kg/m（范围17.9至33.7kg/m）和25.5±5.4kg/m（范围19.2至39.2kg/m）（p = 0.29）]。重建后并发症的发生率在两组之间无显著差异。作者发现，在乳房满意度（p = 0.039）和结果满意度（p = 0.017）领域，保留乳头乳房切除术组重建后的平均得分显著更高。最后，他们注意到，在心理幸福感（p = 0.043）和乳房满意度（p = 0.004）领域，保留乳头乳房切除术组重建后的中位数得分更高。
对恶性肿瘤的心理担忧可能会对乳房切除术前患者的生活质量产生负面影响。重建手术可改善患者乳房切除术后的生活质量。与不保留乳头的乳房切除术相比，保留乳头的乳房切除术似乎能在重建后的生活质量方面带来显著更好的改善，特别是在BREAST-Q的乳房满意度和结果满意度领域。
临床问题/证据水平：治疗性，III级。
