是否应在既往乳房手术后行保留乳头乳晕的乳房切除术？387 例机构病例系列研究

Is Nipple-Sparing Mastectomy Indicated after Previous Breast Surgery? A Series of 387 Institutional Cases.

机构信息

From the Divisions of Breast Surgery, Plastic and Reconstructive Surgery, and Epidemiology and Biostatistics, European Institute of Oncology IRCCS; the Department of Oncology and Hematology-Oncology, University of Milan; and the Universidade Federal do Rio Grande do Sul.

出版信息

Plast Reconstr Surg. 2021 Jul 1;148(1):21-30. doi: 10.1097/PRS.0000000000008097.

DOI:10.1097/PRS.0000000000008097

PMID:34181601

Abstract

BACKGROUND

Previous breast surgery does not represent an absolute contraindication for nipple-sparing mastectomy, although it may negatively interfere with surgical outcomes. The aim of the authors' study was to confirm the feasibility of nipple-sparing mastectomy after previous breast surgery, focusing on skin incisions and risk factors, complications, and oncologic outcomes.

METHODS

The authors retrospectively identified 368 patients who underwent 387 nipple-sparing mastectomies and reconstruction after previous surgery (quadrantectomy, breast resection, augmentation and reduction mammaplasty, mastopexy) at the European Institute of Oncology from January of 2003 to November of 2017. Patterns of skin incisions (i.e., radial, hemiperiareolar, periareolar, vertical pattern, inframammary fold, Wise-pattern, and round-block) for primary surgery and for mastectomy, type of reconstruction, and radiotherapy have been recorded. The authors collected data regarding early and late complications and further operations (implant change, fat grafting) performed within 2 years to improve cosmetic outcomes. Oncologic follow-up has been reported for in-breast recurrences.

RESULTS

Complete and partial nipple-areola complex necrosis occurred, respectively, in 2.8 percent and in 5.4 percent of cases. The authors recorded 5.4 percent failures resulting in implant removal. The analysis of risk factors for complications or for the need for further operations showed no significant association with skin incision for first surgery and mastectomy, use of the same skin incision, previous radiotherapy, or type of primary surgery. Five-year overall survival and disease-free survival were 99.1 and 93.8 percent, respectively. No nipple recurrence was recorded.

CONCLUSIONS

The authors' results confirm that nipple-sparing mastectomy can be a safe surgical procedure after previous breast surgery. Surgical planning should be tailored to each patient.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

摘要

背景

既往乳房手术并非保乳乳房切除术的绝对禁忌证，尽管它可能会对手术结果产生负面影响。作者的研究旨在确认既往乳房手术后行保乳乳房切除术的可行性，重点关注皮肤切口和危险因素、并发症以及肿瘤学结果。

方法

作者回顾性分析了 2003 年 1 月至 2017 年 11 月期间在欧洲肿瘤研究所接受 368 例（象限切除术、乳房切除术、隆乳和缩乳术、乳房提升术）既往手术（象限切除术、乳房切除术、隆乳和缩乳术、乳房提升术）后行 387 例保乳乳房切除术和重建术的患者。记录了首次手术和乳房切除术的皮肤切口模式（即放射状、半乳晕、乳晕、垂直、乳晕下褶皱、Wise 形和圆形）、重建类型和放疗。作者收集了术后 2 年内出现的早期和晚期并发症以及进一步手术（假体更换、脂肪移植）的数据，以改善美容效果。报道了乳房内复发的肿瘤学随访结果。

结果

完全性和部分性乳头乳晕复合体坏死的发生率分别为 2.8%和 5.4%。作者记录了 5.4%的因假体取出而导致的失败病例。对并发症或进一步手术的风险因素进行分析，结果显示与首次手术和乳房切除术的皮肤切口、使用相同的皮肤切口、既往放疗或原发性手术类型均无显著相关性。5 年总生存率和无病生存率分别为 99.1%和 93.8%。未记录到乳头复发。