Miyake Ryo, Kinoshita Satoki, Shimada Naoko, Uchida Ken, Takeyama Hiroshi, Morikawa Toshiaki
Department of Surgery, Jikei University School of Medicine, 3-25-8 Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
Surg Today. 2018 Jun;48(6):591-597. doi: 10.1007/s00595-018-1633-z. Epub 2018 Feb 21.
Skin-sparing mastectomy (SSM) enables a radical cure of breast cancer while overcoming the cosmetic issues related to surgery. We review our experience of performing SSMs and assess whether preservation of the nipple-areola complex (NAC) could have been an option for some patients who underwent SSM.
The subjects of this retrospective study were women who underwent SSM that utilized four incision types; namely, the so-called tennis racket incision, a periareolar and midaxillary incision, an areola-sparing and midaxillary incision, and a small transverse elliptical incision. We assessed whether preservation of the NAC would have been an option in SSM, based on histologic examination of three serial cut surfaces of the specimen around the nipple, ruling out the option when evidence of the malignant lesion/s was found in at least one of the following locations: in the nipple, within a 1-cm radius from the base of the nipple, or within 1 cm from the surface of the NAC.
We performed 193 SSMs. The cumulative 10-year local disease-free survival rate was 98%, with 89% of patients reporting levels of satisfaction with the reconstructed breast, of excellent, very good, or good. We evaluated that 70 of the 193 procedures could have been performed as nipple-sparing mastectomy (NSM).
The outcomes of SSM in this series were excellent and NSM might have been an option for about one-third of the patients.
保留皮肤的乳房切除术（SSM）能够在根治乳腺癌的同时克服与手术相关的美容问题。我们回顾了我们进行SSM的经验，并评估对于一些接受SSM的患者，保留乳头乳晕复合体（NAC）是否可能是一种选择。
这项回顾性研究的对象是接受了采用四种切口类型的SSM的女性；即所谓的网球拍切口、乳晕周围和腋窝中部切口、保留乳晕和腋窝中部切口以及小的横向椭圆形切口。我们根据对乳头周围标本的三个连续切面的组织学检查，评估在SSM中保留NAC是否可能是一种选择，当在以下至少一个位置发现恶性病变证据时排除该选择：乳头内、距乳头基部半径1厘米范围内或距NAC表面1厘米范围内。
我们进行了193例SSM。10年累计局部无病生存率为98%，89%的患者对重建乳房的满意度为优秀、非常好或良好。我们评估193例手术中有70例本可以进行保留乳头的乳房切除术（NSM）。
本系列中SSM的结果非常好，NSM可能是约三分之一患者的一种选择。
