New York, N.Y.
From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center.
Plast Reconstr Surg. 2018 Jun;141(6):795e-804e. doi: 10.1097/PRS.0000000000004404.
Reconstructive trends and outcomes for nipple-sparing mastectomy continue to be defined. The graduated impact of breast size and mastectomy weight remains incompletely evaluated.
All patients undergoing nipple-sparing mastectomy from 2006 to June of 2016 were identified. Demographics and outcomes were analyzed and stratified by mastectomy weight of 800 g or higher (large group), between 799 and 400 g (intermediate group), and less than 400 g (small group).
Of 809 nipple-sparing mastectomies, 66 (8.2 percent) had mastectomy weights of 800 g or higher, 328 (40.5 percent) had mastectomy weights between 799 and 400 g, and 415 nipple-sparing mastectomies (51.3 percent) had mastectomy weights less than 400 g. Nipple-sparing mastectomies in the large group were significantly more likely to be associated with major mastectomy flap necrosis (p = 0.0005), complete nipple-areola complex necrosis (p < 0.0001), explantation (p < 0.0001), cellulitis treated with oral (p = 0.0008) and intravenous (p = 0.0126) antibiotics, abscess (p = 0.0254), and seroma (p = 0.0126) compared with those in the intermediate group. Compared with small nipple-sparing mastectomies, patients in the large group had greater major mastectomy flap necrosis (p < 0.0001), complete (p < 0.0001) and partial (p = 0.0409) nipple-areola complex necrosis, explantation (p < 0.0001), cellulitis treated with oral (p < 0.0001) and intravenous (p < 0.0001) antibiotics, abscess (p = 0.0119), and seroma (p < 0.0001). Patients in the intermediate group were more likely to experience major (p < 0.0001) and minor (p < 0.0001) mastectomy flap necrosis, complete (p = 0.0015) and partial (p < 0.0001) nipple-areola complex necrosis, cellulitis treated with oral antibiotics (p = 0.0062), and seroma (p = 0.0248) compared with those undergoing small nipple-sparing mastectomies. Larger mastectomy weights were significant predictors of complications on logistic regression analysis.
Reconstructive and ischemic complications in nipple-sparing mastectomy are progressively greater as mastectomy weight and breast size increase.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.
保留乳头的乳房切除术的重建趋势和结果仍在不断定义。乳房大小和乳房切除术重量的渐进影响仍未得到充分评估。
确定了 2006 年至 2016 年 6 月期间接受保留乳头的乳房切除术的所有患者。分析了患者的人口统计学数据和结果，并按乳房切除术重量 800 克或以上（大组）、799 至 400 克（中组）和小于 400 克（小组）进行分层。
809 例保留乳头的乳房切除术患者中，66 例（8.2%）的乳房切除术重量为 800 克或以上，328 例（40.5%）的乳房切除术重量在 799 至 400 克之间，415 例保留乳头的乳房切除术（51.3%）的乳房切除术重量小于 400 克。大组的保留乳头的乳房切除术更可能与主要乳房皮瓣坏死（p = 0.0005）、完全乳头乳晕复合体坏死（p < 0.0001）、假体切除（p < 0.0001）、经口（p = 0.0008）和静脉（p = 0.0126）抗生素治疗蜂窝织炎、脓肿（p = 0.0254）和血清肿（p = 0.0126）有关。与小乳房切除术相比，大组患者的主要乳房皮瓣坏死更严重（p < 0.0001）、完全（p < 0.0001）和部分（p = 0.0409）乳头乳晕复合体坏死、假体切除（p < 0.0001）、经口（p < 0.0001）和静脉（p < 0.0001）抗生素治疗蜂窝织炎、脓肿（p = 0.0119）和血清肿（p < 0.0001）。中组患者更有可能经历主要（p < 0.0001）和次要（p < 0.0001）乳房皮瓣坏死、完全（p = 0.0015）和部分（p < 0.0001）乳头乳晕复合体坏死、经口抗生素治疗蜂窝织炎（p = 0.0062）和血清肿（p = 0.0248），与接受小乳房切除术的患者相比。更大的乳房切除术重量是逻辑回归分析中并发症的显著预测因子。
随着乳房切除术重量和乳房大小的增加，保留乳头的乳房切除术的重建和缺血性并发症逐渐增加。
临床问题/证据水平：风险，II。
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