Kontos M, Lanitis S, Constantinidou A, Sakarellos P, Vagios E, Tampaki E C, Tampakis A, Fragoulis M
1st Department of Surgery, National and Kapodistrian University of Athens, Laiko Hospital, 17 Agiou Thoma Street, 11527, Athens, Greece.
1st Department of Surgery, National and Kapodistrian University of Athens, Laiko Hospital, 17 Agiou Thoma Street, 11527, Athens, Greece.
J Plast Reconstr Aesthet Surg. 2020 Apr;73(4):690-695. doi: 10.1016/j.bjps.2019.11.025. Epub 2019 Nov 28.
Breast reconstruction is routinely used to alleviate the psychological adverse effects of mastectomy. Nipple preservation further improves the cosmetic result, and causes less trauma on the body surface. Nipple-sparing mastectomy, however, comes with challenges, especially in the case of large, ptotic breasts to the degree that large-sized breasts have conventionally been a contraindication for nipple preservation. In this report, we describe a novel technique for nipple preservation in immediate reconstruction of large, ptotic breasts.
From 2013 to 2018, 24 patients (30 breasts) with large, ptotic breasts were treated with mastectomy and immediate reconstruction with nipple preservation. Median BMI was 28 and 8 patients were smokers. The technique involves the de-epithelialisation of a large area of the breast skin, the mastectomy through a lateral full-thickness incision within the de-epithelialised area, imbrication of the de-epithelialised skin, lifting of the nipple to a higher position and finally closure of wound.
There were no full, 4 partial nipple necroses and 3 re-operations were done under local anaesthetic to correct partial peripheral necrosis of the areola. Six patients needed seroma aspiration and 4 presented with cellulitis. No implants were lost and there were no delays to adjuvant treatment.
The proposed technique has significant advantages and may be ideal when large skin reductions are necessary in immediate breast reconstruction with nipple preservation. The low complication rate makes the method ideal when adjuvant treatment is to follow and/or patients are of high risk for surgical complications.
乳房重建常用于减轻乳房切除术带来的心理不良反应。保留乳头可进一步改善美容效果，且对体表造成的创伤较小。然而，保留乳头的乳房切除术存在挑战，尤其是对于乳房较大且下垂严重的情况，以至于传统上大乳房一直是保留乳头的禁忌证。在本报告中，我们描述了一种在即刻乳房重建中保留乳头的新技术，用于治疗大而下垂的乳房。
2013年至2018年，对24例（30侧乳房）大而下垂的乳房患者进行了乳房切除术，并即刻进行保留乳头的乳房重建。患者的中位体重指数为28，8例患者吸烟。该技术包括对大面积乳房皮肤进行去上皮化，在去上皮化区域内通过外侧全层切口进行乳房切除术，对去上皮化皮肤进行重叠缝合，将乳头提升至更高位置，最后关闭伤口。
无完全性乳头坏死，4例部分乳头坏死，3例在局部麻醉下再次手术以纠正乳晕部分周边坏死。6例患者需要抽吸血清肿，4例出现蜂窝织炎。无植入物丢失，辅助治疗未延迟。
所提出的技术具有显著优势，在即刻保留乳头的乳房重建中需要大幅减少皮肤时可能是理想的选择。当需要进行辅助治疗和/或患者手术并发症风险较高时，低并发症发生率使该方法成为理想选择。
