Division of Breast Surgery, Department of Women's and Children's Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
Division Plastic Surgery, Department of Women's and Children's Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
Breast J. 2020 Feb;26(2):206-210. doi: 10.1111/tbj.13529. Epub 2019 Sep 9.
Nipple-sparing mastectomy (NSM) has known an exponential diffusion worldwide for prophilaxis and therapeutic mastectomies in selected candidates, being oncologically safe and improving reconstructive outcomes and patients' satisfaction. The two most common used skin incisions are the radial and inframammary fold ones, which represent an imperfect aesthetic solution. The aim of this work was to give insights on our surgical technique, which allows to perform the NSM, node surgery, and endoscopic direct-to-implant reconstruction using a cosmetic axillary incision.
Between June 2016 and January 2019, 7 consecutive patients underwent NSM, lymph node surgery and endoscopic direct-to-implant reconstruction using a small cosmetic axillary incision for breast cancer treatment in a single Institution. An operative rigid endoscope with working channel (Richard Wolf) was used to dissect the entire submuscular-subfascial pocket. The mean age of the patients was 42.8 years old (range: 36-49 years). The evaluation methods were clinical and photography-based assessments, as well as the BREAST-Q which was used to quantify patient satisfaction.
The average follow-up time was 9 months (range 3-22 months). Tumor-free margins were obtained in all cases. No tumor recurrence or metastasis occurred during follow-up. No major complications were experienced. There were no cases of malposition, wrinkling, or rippling. All patients were satisfied with their esthetic results, especially the absence of visible scars.
From our preliminary experience, NSM combined with endoscopic immediate reconstruction via axillary incision for breast cancer treatment seems to be a promising new procedure in cup A and B breasts alternative to the conventional techniques, as it allowed to have safe and pleasant aesthetic and oncologic outcomes.
保乳乳头切除术（NSM）已在全球范围内广泛应用于选择性患者的预防和治疗性乳房切除术，其具有肿瘤安全性，并改善了重建效果和患者满意度。两种最常用的皮肤切口是放射状和乳晕下皱襞切口，但这两种切口的美学效果并不理想。本研究旨在介绍我们的手术技术，该技术可用于通过美容腋窝切口进行 NSM、淋巴结手术和内镜直接植入重建。
在 2016 年 6 月至 2019 年 1 月期间，7 名连续患者在一家医疗机构接受了 NSM、淋巴结手术和内镜直接植入重建，采用小的美容腋窝切口治疗乳腺癌。使用带有工作通道的刚性手术内镜（Richard Wolf）来解剖整个胸肌筋膜下口袋。患者的平均年龄为 42.8 岁（范围：36-49 岁）。评估方法包括临床和摄影评估，以及 BREAST-Q 评估，以量化患者满意度。
平均随访时间为 9 个月（范围 3-22 个月）。所有病例均获得无肿瘤切缘。在随访期间未发生肿瘤复发或转移。没有发生重大并发症。没有出现位置不正、起皱或波纹的情况。所有患者对他们的美学效果都非常满意，特别是没有可见的疤痕。
根据我们的初步经验，对于乳房 A 杯和 B 杯的患者，通过腋窝切口进行 NSM 联合内镜即刻重建似乎是一种很有前途的新技术，可替代传统技术，因为它可以获得安全且令人愉悦的美学和肿瘤学效果。
