Department of Abdominal, Pediatric and Reconstructive Surgery, Plastic Surgery Unit, Antwerp University Hospital, Antwerp, Belgium; Multidisciplinary Breast Clinic, Unit of Gynecologic Oncology, Antwerp University Hospital, Antwerp, Belgium; Clinic 12B, Plastic Surgery Private Clinic, Antwerp, Belgium.
Department of Abdominal, Pediatric and Reconstructive Surgery, Plastic Surgery Unit, Antwerp University Hospital, Antwerp, Belgium.
J Plast Reconstr Aesthet Surg. 2020 Mar;73(3):469-485. doi: 10.1016/j.bjps.2019.11.047. Epub 2019 Dec 18.
Surgeons remain reluctant to perform nipple-sparing mastectomy (NSM) in large breasts due to a higher risk of necrosis. We performed a systematic review of the literature to evaluate indications, techniques, and outcomes in immediate or delayed breast reconstructions in large and/or ptotic breasts.
The following search terms were used for both titles and key words: [NSM AND ("breast ptosis" OR "ptotic breast" OR "large breast" OR "breast hypertrophy" OR "gigantomastia")]. All forms of breast reconstruction in large and/or ptotic breasts from 1990 through September 1st 2018 reporting indications, techniques, and outcomes were included.
Thirty-one studies met the inclusion criteria, yielding 1128 NSMs (709 immediate and 419 delayed) in 629 patients for analysis. The overall complication rate was 29.08%. The mastectomy flap necrosis rate was 12%, the partial nipple-areola complex (NAC) necrosis 11%, and the complete NAC rate 11%. The overall complication rate in one-stage versus delayed reconstructions was 37.52% versus 14.8%. The incidence of necrosis in one-stage versus delayed reconstructions was 5.36% versus 2.15% for partial, 5.08% versus 0.48% for complete NAC necrosis, and 4.8% versus 1.43% for skin flap necrosis.
The majority of studies being small and retrospective as well as the large variation in outcomes indicates that we lack consensus on the timing of reconstruction or ideal technique. A noticeable difference in skin flap and NAC necrosis, however, is seen in the favor of NAC-delayed procedures. Randomized controlled trials are mandatory to prove this difference significantly.
由于坏死风险较高，外科医生在大乳房中仍不愿进行保留乳头的乳房切除术（NSM）。我们对文献进行了系统回顾，以评估大乳房和/或下垂乳房中即刻或延迟乳房重建的适应证、技术和结果。
使用以下搜索词进行标题和关键字搜索：[NSM 和（“乳房下垂”或“下垂乳房”或“大乳房”或“乳房肥大”或“巨乳症”）]。纳入了从 1990 年至 2018 年 9 月 1 日所有形式的大乳房和/或下垂乳房的乳房重建报告适应证、技术和结果的研究。
31 项研究符合纳入标准，对 629 名患者的 1128 例 NSM（709 例即刻和 419 例延迟）进行了分析。总的并发症发生率为 29.08%。乳房切除术皮瓣坏死率为 12%，部分乳头乳晕复合体（NAC）坏死率为 11%，完全 NAC 坏死率为 11%。一期与延迟重建的总并发症发生率分别为 37.52%和 14.8%。一期与延迟重建的 NAC 部分坏死发生率分别为 5.36%和 2.15%，完全 NAC 坏死发生率分别为 5.08%和 0.48%，皮瓣坏死发生率分别为 4.8%和 1.43%。
大多数研究规模较小且为回顾性，且结果差异较大，表明我们在重建时间或理想技术方面缺乏共识。然而，在 NAC 延迟手术中，NAC 皮瓣和 NAC 坏死的差异明显。需要进行随机对照试验来证明这种差异具有统计学意义。
