Frey Jordan D, Salibian Ara A, Choi Mihye, Karp Nolan S
Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, N.Y.
Plast Reconstr Surg Glob Open. 2019 Jan 11;7(1):e2103. doi: 10.1097/GOX.0000000000002103. eCollection 2019 Jan.
Nipple-sparing mastectomy (NSM) places greater stress on the breast-skin envelope compared with traditional mastectomy techniques. Precise mastectomy flap dissection is critical to optimize breast skin flap thickness and minimize complication risk. This study evaluated patient-specific factors associated with mastectomy flap quality to improve technical success in NSM. Ideal NSM flap thickness was determined for all NSMs from 2006 to 2016 with available preoperative breast magnetic resonance imaging (MRIs). Demographic, operative variables, and flap thickness were compared for NSMs as stratified by body mass index (BMI) and mastectomy weight. Of the 1,037 NSMs, 420 cases (40.5%; 243 patients) had MRI data available, which included 379 (36.5%) preoperative breast MRIs. Average BMI was 24.08 kg/m, whereas average mastectomy weight was 442.28 g. NSMs were classified according to BMI <25 kg/m, 25-30 kg/m, and >30 kg/m. Average ideal overall NSM flap thicknesses in these groups were 10.43, 12.54, and 14.91 mm, respectively. Each incremental increase in average overall NSM flap thickness per BMI category was statistically significant ( < 0.0001; < 0.0001; = 0.0002). NSMs were also classified into mastectomy weight categories: <400 g, 400-799 g, and ≥800 g. Average overall NSM flap thicknesses in these groups were 9.97, 12.21, and 14.50 mm, respectively. Each incremental increase in average overall NSM flap thickness per mastectomy weight category was similarly statistically significant ( < 0.0001; < 0.0001; < 0.0001). NSM flap thickness and quality is related to BMI and breast size. Characterizing these anatomic variations preoperatively will help surgeons optimize mastectomy flap dissections and minimize ischemic complications in breast reconstruction after NSM.
与传统乳房切除术技术相比，保乳乳房切除术（NSM）对乳房皮肤包膜造成更大压力。精确的乳房切除皮瓣解剖对于优化乳房皮瓣厚度和降低并发症风险至关重要。本研究评估了与乳房切除皮瓣质量相关的患者特定因素，以提高NSM的技术成功率。利用2006年至2016年期间所有可获得术前乳房磁共振成像（MRI）的NSM确定理想的NSM皮瓣厚度。将NSM按体重指数（BMI）和乳房切除重量分层，比较其人口统计学、手术变量和皮瓣厚度。在1037例NSM中，420例（40.5%；243例患者）有可用的MRI数据，其中包括379例（36.5%）术前乳房MRI。平均BMI为24.08kg/m，而平均乳房切除重量为442.28g。NSM根据BMI<25kg/m、25 - 30kg/m和>30kg/m进行分类。这些组中平均理想的总体NSM皮瓣厚度分别为10.43、12.54和14.91mm。每个BMI类别中平均总体NSM皮瓣厚度的每一次增量增加均具有统计学意义（<0.0001；<0.0001； = 0.0002）。NSM也被分为乳房切除重量类别：<400g、400 - 799g和≥800g。这些组中平均总体NSM皮瓣厚度分别为9.97、12.21和14.50mm。每个乳房切除重量类别中平均总体NSM皮瓣厚度的每一次增量增加同样具有统计学意义（<0.0001；<0.0001；<0.0001）。NSM皮瓣厚度和质量与BMI和乳房大小有关。术前了解这些解剖变异将有助于外科医生优化乳房切除皮瓣解剖，并在NSM后的乳房重建中减少缺血性并发症。
