From the Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine; the Department of Plastic and Reconstructive Surgery, Inje University Busan Paik Hospital; the Department of Economics, University of Chicago; and the Department of Plastic, Hand, and Reconstructive Surgery, BG Unfallklinik.
Plast Reconstr Surg. 2020 Mar;145(3):491e-498e. doi: 10.1097/PRS.0000000000006544.
After breast reconstruction, nipple position and other long-term changes in the reconstructed breast relative to the contralateral breast remain poorly understood. In this prospective cohort study, the authors performed serial nipple position measurements over 5 years in patients who had undergone breast reconstruction with a transverse rectus abdominis musculocutaneous (TRAM) flap. The effects of adjuvant radiotherapy on nipple position over time were also investigated.
The authors studied 150 patients who had undergone nipple-sparing mastectomy, using radial incision followed by immediate unilateral pedicled TRAM flap breast reconstruction. Measurements of sternal notch-to-nipple, midline-to-nipple, and inframammary fold-to-nipple distances were performed 1 day before reconstruction and 6, 12, 36, and 60 months after surgery, on patients' reconstructed and nonoperated breasts.
The average sternal notch-to-nipple distance increased in both reconstructed and nonoperated breasts at every follow-up visit, with an average difference of 0.393 cm at the 60-month visit (p < 0.0001). Comparing the pattern of distance change, reconstructed breasts tend to change more slowly than nonoperated breasts until 36 months postoperatively. In irradiated breasts, the sternal notch-to-nipple distance was significantly smaller than in nonirradiated breasts, and nipple position changed minimally between 1 and 3 years after surgery.
Nipple position in TRAM flap-reconstructed breasts changed over time compared with that in nonoperated breasts, especially along the vertical axis. The pattern of nipple position change in reconstructed breasts became similar to nonoperated breasts 3 years after surgery. In patients who had undergone adjuvant radiation therapy, nipple position remained consistent for 1 to 3 years.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
乳房重建后，重建乳房相对于对侧乳房的乳头位置和其他长期变化仍知之甚少。在这项前瞻性队列研究中，作者对接受横形腹直肌肌皮瓣（TRAM）乳房重建的患者进行了 5 年的连续乳头位置测量，研究了辅助放疗对随时间推移的乳头位置的影响。
作者研究了 150 名接受过保留乳头的乳房切除术的患者，采用放射状切口，随后立即进行单侧带蒂 TRAM 皮瓣乳房重建。在重建前 1 天以及手术后 6、12、36 和 60 个月，对患者的重建侧和未手术侧乳房进行胸骨切迹到乳头、中线到乳头和乳晕下褶皱到乳头的距离测量。
在每次随访中，重建侧和未手术侧的胸骨切迹到乳头的距离均增加，在 60 个月的随访中平均差异为 0.393cm（p<0.0001）。比较距离变化的模式，重建乳房在术后 36 个月之前的变化速度比未手术乳房慢。在接受放疗的乳房中，胸骨切迹到乳头的距离明显小于未放疗的乳房，并且在手术后 1 至 3 年内乳头位置变化很小。
与未手术侧乳房相比，TRAM 皮瓣重建乳房的乳头位置随时间发生变化，尤其是在垂直轴上。重建乳房的乳头位置变化模式在手术后 3 年变得与未手术乳房相似。在接受辅助放疗的患者中，乳头位置在 1 至 3 年内保持稳定。
临床问题/证据水平：治疗，IV。
