经腋路内镜辅助即刻假体乳房重建的保乳术：迈向循证和个体化手术的又一步。

Therapeutic nipple-sparing mastectomy combined with endoscopic immediate prosthetic breast reconstruction via axillary incision. A further step towards evidence-based and personalized surgery.

出版信息

Ann Ital Chir. 2020;91:417-425.

Abstract

INTRODUCTION

Nipple-sparing mastectomy is an oncologically validated technique for selected breast cancer patients and allows to improve aesthetic results and patients' quality of life. Conventional skin incisions are often a suboptimal solution due to the visibility of the scars. Aim of this work is to show our innovative technique, which allows to perform nipple-sparing mastectomy, lymph-node surgery, and endoscopic immediate prosthetic breast reconstruction using a single cosmetic axillary incision.

MATERIALS AND METHODS

Between June 2016 and October 2019, 14 consecutive patients underwent therapeutic nipple- sparing mastectomy with endoscopic immediate reconstruction via axillary incision; inclusion criteria were cup A or B breasts and tumors less than 3 cm in diameter. Data were recorded in order to evaluate reproducibility, feasibility, safety, aesthetic outcomes and patients' quality of life.

RESULTS

Mean age was 46 years old (range: 34-54 years); median tumor size was 1.7 cm; average follow-up time was 11 months (range 3-42); median operation time was 340 minutes; mean hospital stay was 4,1 days. Tumor-free margins were obtained in all 14 cases. No local-regional recurrence occurred during follow-up. No major complications were experienced. No systemic complications were observed. All patients were satisfied with their aesthetic results, especially the absence of visible scars.

CONCLUSIONS

Therapeutic nipple-sparing mastectomy with endoscopic immediate prosthetic reconstruction via axillary incision is a safe and appropriate procedure in cup A and B breasts, alternative to conventional techniques. It allows to improve aesthetic outcomes and patients' quality of life thanks to a single well-hidden axillary scar.

KEY WORDS

Axillary Incision, Breast Cancer, Endoscopic Breast Reconstruction, Nipple-Sparing Mastectomy, Oncological and Aesthetic Outcomes, Quality of Life.

摘要

引言

保乳乳头切除术是一种经过验证的针对特定乳腺癌患者的肿瘤学技术，它可以改善美容效果和患者的生活质量。传统的皮肤切口由于疤痕的可见性往往不是最佳解决方案。本文旨在展示我们的创新技术，该技术可通过单一切口（腋窝）进行保乳乳头切除术、淋巴结手术和内镜即刻假体乳房重建。

材料和方法

2016 年 6 月至 2019 年 10 月，14 例连续患者接受了经腋窝切口的保乳乳头切除术和内镜即刻重建术；纳入标准为乳房杯 A 或 B 以及直径小于 3 厘米的肿瘤。记录数据以评估可重复性、可行性、安全性、美容效果和患者的生活质量。

结果

平均年龄为 46 岁（范围：34-54 岁）；中位肿瘤大小为 1.7 厘米；平均随访时间为 11 个月（范围 3-42）；中位手术时间为 340 分钟；平均住院时间为 4.1 天。所有 14 例均获得肿瘤切缘无肿瘤。随访期间无局部复发。未发生重大并发症。未观察到全身并发症。所有患者均对其美容效果满意，特别是没有可见的疤痕。