Lee Jun-Ho, Choi Manki, Sakong Yong
Department of Plastic and Reconstructive Surgery, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, Korea.
Gland Surg. 2021 Jan;10(1):290-297. doi: 10.21037/gs-20-606.
Since the introduction of skin-sparing mastectomy (SSM), more breast surgeons have been preserving the areola and often nipple areolar complex (NAC) entirely. For better outcomes, more studies are necessary to analyze whether preserving the areola or NAC is unfavorable in breast reconstruction. The aim of this study was to assess the potential risk of areola or NAC preservation in direct-to-implant (DTI) breast reconstruction after SSM.
We retrospectively reviewed the medical records of patients who underwent immediate breast reconstruction from May 2011 to July 2017. Immediate breast reconstruction was performed with DTI procedure in all cases. In total, 213 breasts met the inclusion criteria and were divided into 3 groups: nipple-sparing mastectomy (NSM), aerola-sparing mastectomy (ASM) which only nipple is excised, and skin-sparing mastectomy (SSM) which whole NAC was excised. Complications including infection, capsular contracture, skin necrosis and explantation were measured.
The mean patient age was 45.3 years, with a range of 27-62 years; the mean follow-up was 3.08 years. NSM, ASM and SSM groups consisted of 121, 30 and 62 breasts, respectively. The Infection rates were statistically lower in SSM group (4.8%) compared with NSM group (15.7%) (P=0.033) but not statistically different from ASM group (13.3%) (P=0.210). SSM group showed significantly lower rate of overall complication compared with both NSM and ASM groups (P=0.005, 0.025 respectively).
Our research suggests that preservation of the NAC increases the rate of infection and skin necrosis in DTI breast reconstruction.
自从引入保留皮肤的乳房切除术（SSM）以来，越来越多的乳腺外科医生开始保留乳晕，并且常常完整保留乳头乳晕复合体（NAC）。为了获得更好的结果，需要更多研究来分析保留乳晕或NAC在乳房重建中是否不利。本研究的目的是评估SSM后直接植入式（DTI）乳房重建中保留乳晕或NAC的潜在风险。
我们回顾性分析了2011年5月至2017年7月期间接受即刻乳房重建患者的病历。所有病例均采用DTI手术进行即刻乳房重建。共有213个乳房符合纳入标准，分为3组：保留乳头的乳房切除术（NSM）、仅切除乳头的保留乳晕的乳房切除术（ASM）和切除整个NAC的保留皮肤的乳房切除术（SSM）。测量包括感染、包膜挛缩、皮肤坏死和取出植入物在内的并发症。
患者平均年龄为45.3岁，范围为27 - 62岁；平均随访时间为3.08年。NSM组、ASM组和SSM组分别包括121个、30个和62个乳房。SSM组的感染率（4.8%）与NSM组（15.7%）相比有统计学意义的降低（P = 0.033），但与ASM组（13.3%）相比无统计学差异（P = 0.210）。SSM组的总体并发症发生率显著低于NSM组和ASM组（分别为P = 0.005，0.025）。
我们的研究表明，在DTI乳房重建中保留NAC会增加感染和皮肤坏死的发生率。
