组织扩张器乳头不对称对双侧保留乳头乳晕乳房切除术（NSM）后最终假体对称性的影响。

The Impact of Tissue Expander Nipple Asymmetry on Final Implant Symmetry After Bilateral Nipple Sparing Mastectomy.

机构信息

From the Division of Plastic and Reconstructive Surgery.

出版信息

Ann Plast Surg. 2022 Jun 1;88(5 Suppl 5):S427-S432. doi: 10.1097/SAP.0000000000003161.

DOI:10.1097/SAP.0000000000003161

PMID:35690938

Abstract

BACKGROUND

Asymmetry of nipple position is common in the female population and very difficult to correct after nipple sparing mastectomy (NSM). There are scant data on the impact of tissue expander (TE) nipple asymmetry on final implant nipple symmetry after bilateral NSM.

METHODS

A retrospective review of an institutional review board-approved prospective database of NSM and immediate 2-stage implant reconstruction between June 2014 and December 2019 was performed. BCCT.core software was used to examine TE and final implant nipple asymmetry as well as relative breast implant position. Horizontal and/or vertical asymmetry and breast retraction assessment (BRA) were evaluated. Moderate asymmetry was defined as ≥1 cm and severe asymmetry as ≥2 cm. Lower breast contour ≥1 cm defined implant malposition.

RESULTS

Twenty-three patients met the inclusion criteria. Linear regression analysis showed a significant relationship between TE BRA and final BRA (R2 = 0.2321, P = 0.02) with a mean TE BRA of 2.04 and a mean final BRA of 1.53 (P = 0.05). Tissue expander nipple asymmetry was predictive of final BRA score: no TE asymmetry, 0.87, versus TE nipple asymmetry, 1.67 (P = 0.02). Tissue expander lower breast contour ≥1 cm occurred in 8 patients (36.4%) and was associated with implant nipple asymmetry in 7 (87.5%). The second stage of reconstruction significantly improved the nipple asymmetry in those with TE malposition (TE BRA, 2.34, vs final BRA, 1.67; P = 0.05). Two patients who received radiation had increased BRA scores (radiation, 2.14, vs no radiation, 1.47; P = 0.004).

CONCLUSIONS

Tissue expander nipple asymmetry as measured by BRA score or nipple asymmetry was predictive of final nipple symmetry. The second stage of TE reconstruction improves the nipple asymmetry. Final implant exchange can allow for pocket and implant manipulation, improving nipple symmetry. Radiation therapy to TE reconstruction has a negative impact on nipple symmetry after the final stage.

摘要

背景

乳头位置不对称在女性人群中很常见，且在保留乳头的乳房切除术（NSM）后很难纠正。关于组织扩张器（TE）乳头不对称对双侧 NSM 后最终植入物乳头对称性的影响的数据很少。

方法

对 2014 年 6 月至 2019 年 12 月期间经机构审查委员会批准的 NSM 和即刻 2 期植入物重建的前瞻性数据库进行回顾性审查。使用 BCCT.core 软件检查 TE 和最终植入物乳头的不对称以及相对乳房植入物的位置。评估水平和/或垂直不对称和乳房回缩评估（BRA）。中度不对称定义为≥1cm，严重不对称定义为≥2cm。下乳房轮廓≥1cm 定义为植入物位置不当。

结果

23 名患者符合纳入标准。线性回归分析显示，TE BRA 与最终 BRA 之间存在显著关系（R2=0.2321，P=0.02），TE BRA 的平均值为 2.04，最终 BRA 的平均值为 1.53（P=0.05）。TE 乳头不对称是最终 BRA 评分的预测指标：无 TE 不对称，0.87，与 TE 乳头不对称，1.67（P=0.02）。8 名患者（36.4%）出现 8 例 TE 下乳房轮廓≥1cm，其中 7 例（87.5%）与植入物乳头不对称相关。二期重建显著改善了 TE 位置不当患者的乳头不对称（TE BRA，2.34，与最终 BRA，1.67；P=0.05）。2 名接受放疗的患者的 BRA 评分增加（放疗，2.14，与未放疗，1.47；P=0.004）。