From the Departments of Surgery and Plastic Surgery, MedStar Georgetown University Hospital; Georgetown University School of Medicine; Department of Surgery, Queen Elizabeth Hospital; and private practice.
Plast Reconstr Surg. 2020 Feb;145(2):251e-262e. doi: 10.1097/PRS.0000000000006439.
The authors refine their anatomical patient selection criteria with a novel midclavicular-to-inframammary fold measurement for nipple-sparing mastectomy performed through an inframammary approach.
Retrospective review was performed of all nipple-sparing mastectomies performed through an inframammary approach. Exclusion criteria included other mastectomy incisions, staged mastectomy, previous breast operation, and autologous reconstruction. Preoperative anatomical measurements for each breast, clinical course, and specimen weight were obtained.
One hundred forty breasts in 79 patients were analyzed. Mastectomy weight, but not sternal notch-to-nipple distance, was strongly correlated with midclavicular-to-inframammary fold measurement on linear regression (R = 0.651; p < 0.001). Mastectomy weight was not correlated with ptosis. Twenty-five breasts (17.8 percent) had ischemic complications: 16 (11.4 percent) were nonoperative and nine (6.4 percent) were operative. Those with mastectomy weights of 500 g or greater were nine times more likely to have operative ischemic complications than those with mastectomy weights less than 500 g (p = 0.0048). Those with a midclavicular-to-inframammary fold measurement of 30 cm or greater had a 3.8 times increased incidence of any ischemic complication (p = 0.00547) and a 9.2 times increased incidence of operative ischemic complications (p = 0.00376) compared with those whose midclavicular-to-inframammary fold measurement was less than 30 cm.
Breasts undergoing nipple-sparing mastectomy by means of an inframammary approach with midclavicular-to-inframammary fold measurement greater than or equal to 30 cm are at higher risk for having ischemic complications, warranting consideration for a staged approach or other incision. The midclavicular-to-inframammary fold measurement is useful for assessing the entire breast and predicting the likelihood of ischemic complications in inframammary nipple-sparing mastectomies.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
作者通过经乳晕入路行保留乳头乳晕乳房切除术，提出一种新的锁骨中线至乳晕下皱襞测量方法，用于改良该术式的患者选择标准。
对所有经乳晕入路行保留乳头乳晕乳房切除术的患者进行回顾性研究。排除标准包括其他乳房切除术切口、分期乳房切除术、既往乳房手术和自体重建。获得每个乳房的术前解剖测量值、临床过程和标本重量。
分析了 79 例患者的 140 个乳房。线性回归分析显示，乳房切除术的重量而不是胸骨切迹至乳头的距离与锁骨中线至乳晕下皱襞的测量值呈强相关（R = 0.651；p < 0.001）。乳房切除术的重量与乳房下垂无关。25 个乳房（17.8%）出现缺血性并发症：16 个（11.4%）为非手术治疗，9 个（6.4%）为手术治疗。那些乳房切除术重量为 500 g 或以上的患者发生手术性缺血性并发症的可能性是乳房切除术重量小于 500 g 的患者的 9 倍（p = 0.0048）。锁骨中线至乳晕下皱襞测量值为 30 cm 或更大的患者，发生任何缺血性并发症的风险增加 3.8 倍（p = 0.00547），发生手术性缺血性并发症的风险增加 9.2 倍（p = 0.00376）与锁骨中线至乳晕下皱襞测量值小于 30 cm 的患者相比。
通过乳晕入路行保留乳头乳晕乳房切除术，锁骨中线至乳晕下皱襞测量值大于或等于 30 cm 的乳房发生缺血性并发症的风险较高，需要考虑分期手术或其他切口。锁骨中线至乳晕下皱襞的测量值可用于评估整个乳房，并预测乳晕入路保留乳头乳晕乳房切除术中缺血性并发症的可能性。
临床问题/证据水平：风险，III 级。
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