Breast Services Division, Department of General Surgery, Cleveland Clinic Cleveland Ohio USA.
Department of Plastic Surgery, Cleveland Clinic Cleveland Ohio USA.
BJS Open. 2018 Nov 26;3(2):169-173. doi: 10.1002/bjs5.50117. eCollection 2019 Apr.
Bilateral nipple-sparing mastectomy (NSM) is a technically feasible operation and is associated with excellent cosmetic outcomes. The aim of this study was to evaluate trends in patient characteristics, indications for surgery and long-term outcomes of bilateral NSM for breast cancer risk reduction over time.
A review of a single-centre experience with bilateral NSM performed between 2001 and 2017 for breast cancer risk reduction in patients without breast cancer was performed. Trends in patient characteristics and indications for surgery were evaluated over four time intervals: 2001-2005, 2006-2009, 2010-2013 and 2014-2017. Statistical analysis was performed using χ tests.
Over the study period, 272 NSMs were performed in 136 patients; their median age was 41 years. The number of bilateral NSMs performed increased over time. The most common indication was a mutation in breast cancer-associated genes (104 patients, 76·5 per cent), which included (62 patients), (35), (2), (3) and (2). Other indications were family history of breast cancer (19 patients, 14·0 per cent), lobular carcinoma (10, 7·4 per cent) and a history of mantle irradiation (3, 2·2 per cent). The proportion of patients having a bilateral NSM for mutation in a breast cancer-associated gene increased over time (2001-2005: 2 of 12; 2006-2009: 9 of 17; 2010-2013: 34 of 41; 2014-2017: 61 of 66; < 0·001). Mean follow-up was 53 months; no breast cancers were found during follow-up.
The use of bilateral NSM for breast cancer risk reduction is increasing and the indications have evolved over the past 16 years. These excellent long-term oncological results suggest that bilateral NSM is a good option for surgical breast cancer risk reduction.
双侧保留乳头的乳房切除术（NSM）是一种技术上可行的手术，与极佳的美容效果相关。本研究的目的是评估随着时间的推移，双侧 NSM 用于降低乳腺癌风险的患者特征、手术指征和长期结果的趋势。
对 2001 年至 2017 年间因乳腺癌风险降低而在无乳腺癌患者中进行的单侧 NSM 经验进行了单中心回顾。评估了四个时间段内（2001-2005 年、2006-2009 年、2010-2013 年和 2014-2017 年）患者特征和手术指征的趋势。使用 χ 检验进行统计分析。
研究期间，136 例患者共行 272 例双侧 NSM，中位年龄为 41 岁。双侧 NSM 的数量随时间推移而增加。最常见的指征是乳腺癌相关基因的突变（104 例，76.5%），包括 （62 例）、 （35 例）、 （2 例）、 （3 例）和 （2 例）。其他指征包括乳腺癌家族史（19 例，14.0%）、小叶癌 （10 例，7.4%）和胸壁放疗史（3 例，2.2%）。具有乳腺癌相关基因突变的双侧 NSM 患者比例随时间推移而增加（2001-2005 年：2/12；2006-2009 年：9/17；2010-2013 年：34/41；2014-2017 年：61/66； < 0·001）。中位随访时间为 53 个月；随访期间未发现乳腺癌。
双侧 NSM 用于降低乳腺癌风险的应用正在增加，并且在过去 16 年中指征已经发生了演变。这些极佳的长期肿瘤学结果表明，双侧 NSM 是一种降低乳腺癌风险的良好手术选择。
