Breast Service, Department of Surgery, New York, USA.
Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, USA.
Br J Surg. 2020 Sep;107(10):1307-1312. doi: 10.1002/bjs.11616. Epub 2020 May 20.
Nipple-sparing mastectomy (NSM) is being performed increasingly for risk reduction in high-risk groups. There are limited data regarding complications and oncological outcomes in women undergoing bilateral prophylactic NSM. This study reviewed institutional experience with prophylactic NSM, and examined the indications, rates of postoperative complications, incidence of occult malignant disease and subsequent breast cancer diagnosis.
Women who had bilateral prophylactic NSM between 2000 and 2016 were identified from a prospectively maintained database. Rates of postoperative complications, incidental breast cancer, recurrence and overall survival were evaluated.
A total of 192 women underwent 384 prophylactic NSMs. Indications included BRCA1 or BRCA2 mutations in 117 patients (60·9 per cent), family history of breast cancer in 35 (18·2 per cent), lobular carcinoma in situ in 29 (15·1 per cent) and other reasons in 11 (5·7 per cent). Immediate breast reconstruction was performed in 191 patients. Of 384 NSMs, 116 breasts (30·2 per cent) had some evidence of skin necrosis at follow-up, which resolved spontaneously in most; only 24 breasts (6·3 per cent) required debridement. Overall, there was at least one complication in 129 breasts (33·6 per cent); 3·6 and 1·6 per cent had incidental findings of ductal carcinoma in situ and invasive breast cancer respectively. The nipple-areola complex was preserved entirely in 378 mastectomies. After a median follow-up of 36·8 months, there had been no deaths and no new breast cancer diagnoses.
These findings support the use of prophylactic NSM in high-risk patients. The nipples could be preserved in the majority of patients, postoperative complication rates were low, and, with limited follow-up, there were no new breast cancers.
保留乳头的乳房切除术（NSM）在高危人群中越来越多地用于降低风险。在接受双侧预防性 NSM 的女性中，关于并发症和肿瘤学结果的数据有限。本研究回顾了机构在预防性 NSM 方面的经验，并检查了手术并发症、隐匿性恶性疾病的发生率以及随后的乳腺癌诊断。
从一个前瞻性维护的数据库中确定了 2000 年至 2016 年间接受双侧预防性 NSM 的女性。评估了术后并发症、意外乳腺癌、复发和总生存率的发生率。
共有 192 名女性接受了 384 次预防性 NSM。适应证包括 BRCA1 或 BRCA2 突变 117 例（60.9%）、乳腺癌家族史 35 例（18.2%）、小叶原位癌 29 例（15.1%）和其他原因 11 例（5.7%）。191 名患者进行了即刻乳房重建。在 384 例 NSM 中，116 例乳房（30.2%）在随访时有皮肤坏死的证据，大多数情况下会自行愈合；只有 24 例乳房（6.3%）需要清创。总体而言，129 例乳房（33.6%）至少有一处并发症；3.6%和 1.6%分别有导管原位癌和浸润性乳腺癌的偶然发现。378 例乳房切除术完全保留了乳头乳晕复合体。中位随访 36.8 个月后，无死亡病例，也无新的乳腺癌诊断。
这些发现支持在高危患者中使用预防性 NSM。大多数患者的乳头可以保留，术后并发症发生率低，在有限的随访中，没有新发乳腺癌。
