Ghidei Luwam, Bansil Hannah A, Stuckey Ashley, Pandya Sonali, Edmonson David, Michaud Pierre, Gass Jennifer
Department of Obstetrics and Gynecology, Women & Infants Hospital of Rhode Island, Providence, R.I.
Women & Infants Hospital Breast Health Center, Women & Infants Hospital of Rhode Island, Providence, R.I.
Plast Reconstr Surg Glob Open. 2020 Feb 24;8(2):e2623. doi: 10.1097/GOX.0000000000002623. eCollection 2020 Feb.
Nipple-sparing mastectomies are increasingly offered to women with breast cancer given the evidence for oncologic safety and improved cosmetic outcomes. Women with significant ptosis are often excluded due to potential nipple malposition and increased risk of nipple ischemia. The use of a harvested free nipple graft may allow women with ptosis to conserve their nipple -areolar complex.
This is an IRB approved retrospective study of breast cancer patients at an academic center with ptosis who underwent free-nipple graft mastectomies with a single plastic surgeon and 5 dedicated breast surgeons from 2014-2017. The primary outcomes were free nipple graft viability and the need for revision. Secondary outcomes included post-operative complications.
Fourteen women with ptosis underwent skin and nipple-sparing mastectomy with breast reconstruction involving use of harvested free-nipple graft. More than half of the women were diagnosed with early-stage invasive breast cancer (42% stage 1, 14% stage 2). Four women underwent mastectomy for prophylaxis or other benign reasons. All of the women had significant ptosis during the pre-operative evaluation (57% grade 2 ptosis, 36% grade 3 ptosis, and 7% uncategorized), with an average BMI of 30. None were active smokers. In the postoperative period, one had partial nipple necrosis in combination with skin flap necrosis and positive margin (7%). Other complications included infection (14%) and hypopigmentation (14%). All nipples lost sensation and full projection.
This is a novel approach using a free nipple graft with a skin envelope reducing mastectomy and immediate expander-based reconstruction. This successful approach allows women with ptosis to undergo nipple-sparing mastectomy with preservation of the nipple -areolar complex.
鉴于保乳手术在肿瘤学安全性和改善美容效果方面的证据，越来越多的乳腺癌女性接受保乳手术。由于存在乳头位置异常和乳头缺血风险增加的可能性，乳房严重下垂的女性通常被排除在外。使用采集的游离乳头移植可能使乳房下垂的女性保留其乳头乳晕复合体。
这是一项经机构审查委员会批准的对某学术中心2014年至2017年期间接受游离乳头移植乳房切除术的乳房下垂乳腺癌患者的回顾性研究。这些患者由一名整形外科医生和五名专门的乳腺外科医生进行手术。主要结局是游离乳头移植的存活情况和修复需求。次要结局包括术后并发症。
14名乳房下垂的女性接受了保留皮肤和乳头的乳房切除术，并进行了乳房重建，其中包括使用采集的游离乳头移植。超过一半的女性被诊断为早期浸润性乳腺癌（42%为1期，14%为2期）。4名女性因预防性手术或其他良性原因接受了乳房切除术。所有女性在术前评估时均有明显的乳房下垂（57%为2级下垂，36%为3级下垂，7%未分类），平均体重指数为30。无人为现役吸烟者。术后，1名患者出现部分乳头坏死，同时伴有皮瓣坏死和切缘阳性（7%）。其他并发症包括感染（14%）和色素沉着不足（14%）。所有乳头均失去感觉和完全突出。
这是一种使用带有皮肤包膜的游离乳头移植的新方法，可减少乳房切除术并立即进行基于扩张器的重建。这种成功的方法使乳房下垂的女性能够接受保留乳头的乳房切除术，同时保留乳头乳晕复合体。
