Department of General, Thoracic and Vascular Surgery, Virginia Mason Medical Center, Seattle, WA, USA.
Providence Saint John's Health Center, John Wayne Cancer Institute, Santa Monica, CA, USA.
Ann Surg Oncol. 2019 Dec;26(13):4284-4293. doi: 10.1245/s10434-019-07731-y. Epub 2019 Sep 9.
Breast-conserving therapy (BCT) has been associated with better quality of life and cosmetic outcomes than mastectomy. However, subareolar cancers abutting the nipple-areolar complex (NAC) present a unique cosmetic and oncologic challenge. Oncoplastic central partial mastectomy and neoareolar reduction mammoplasty with immediate nipple reconstruction is a novel technique that can permit BCT for these patients.
This study enrolled consecutive patients with central tumors during 2017-2018 who underwent central partial mastectomy reconstructed with neoareolar reduction mammoplasty and immediate nipple reconstruction. Patient demographics, imaging and pathology size, margin width, mastectomy and reexcision rates, and cosmesis were evaluated.
The study identified 23 sequential patients. The average patient age was 60.5 ± 12.3 years, and the average body mass index was 29.4 ± 5.7 kg/m. The mean lesion size was 51.5 ± 43.0 mm on preoperative imaging, and the average disease span shown by the final pathology was 59.5 ± 45.3 mm. "No ink on tumor" was achieved for 22 patients (95.7%). In 13 patients (56.5%), the margins were inadequate for ductal carcinoma in situ (DCIS) (n = 12) or invasive cancer (n = 1). Good to excellent cosmetic results were achieved for 21 patients (95.5%). Complications occurred for six patients (26.1%), including three patients with ischemia of the reconstructed NAC.
The single-stage operation described in this report can allow patients with cancers abutting the NAC to consider BCT. This technique allows patients to avoid mastectomy and to minimize the number of operations required for reconstruction while maximizing cosmetic outcomes. In the study cohort, the presence of extensive DCIS resulted in a significant need for reexcision, which could be performed successfully without compromise to cosmetic outcome.
保乳治疗（BCT）与乳房切除术相比，能带来更好的生活质量和美容效果。然而，乳晕旁的癌症紧贴乳晕复合体（NAC），这给美容和肿瘤学带来了独特的挑战。保乳术的新方法是乳晕中央部分乳房切除术和新乳晕缩小成形术联合即刻乳头重建术。
本研究纳入了 2017 年至 2018 年间接受乳晕中央肿瘤切除术，并用新乳晕缩小成形术和即刻乳头重建术进行重建的连续患者。评估了患者的人口统计学资料、影像学和病理学大小、切缘宽度、乳房切除术和再次切除术的比率以及美容效果。
研究共纳入了 23 例连续患者。患者的平均年龄为 60.5 ± 12.3 岁，平均体重指数为 29.4 ± 5.7 kg/m。术前影像学上病变平均大小为 51.5 ± 43.0 mm，最终病理平均病变范围为 59.5 ± 45.3 mm。22 例（95.7%）患者达到了“无肿瘤墨染”。13 例（56.5%）患者因导管原位癌（DCIS）（n=12）或浸润性癌（n=1）切缘不足。21 例（95.5%）患者获得了良好到极好的美容效果。6 例（26.1%）患者发生并发症，包括 3 例重建的 NAC 缺血。
本报告中描述的单阶段手术可使 NAC 旁癌症患者考虑 BCT。该技术可使患者避免乳房切除术，减少重建所需的手术次数，同时最大限度地提高美容效果。在研究队列中，广泛的 DCIS 的存在导致了对再次切除术的强烈需求，这可以在不影响美容效果的情况下成功地完成。
