Ostapenko Edvin, Nixdorf Larissa, Devyatko Yelena, Exner Ruth, Math Pia, Wimmer Kerstin, Haeusler Theresa, Fitzal Florian
From the Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
Plast Reconstr Surg Glob Open. 2023 May 26;11(5):e5032. doi: 10.1097/GOX.0000000000005032. eCollection 2023 May.
In recent years, nipple-sparing mastectomy followed by implant-based breast reconstruction has gained popularity due to improved cosmetic and psychological benefits. However, patients with ptotic breasts remain the main challenge for surgeons, owing to the potential risk of postoperative complications.
A retrospective chart review was performed for patients who underwent nipple-sparing mastectomy and prepectoral implant-based breast reconstruction between March 2017 and November 2021. Patient demographics, incidence of complications, and quality of life assessed using the BREAST-Q questionnaire were compared between the two different incisions [inverted-T for ptotic versus inframammary fold (IMF) for nonptotic breasts].
A total of 98 patients were examined: 62 in the IMF cohort and 36 in the inverted-T cohort. The results demonstrated equivalence in the safety metrics between the two groups, including hematoma (p=0.367), seroma (p=0.552), infection ( = 1.00), skin necrosis ( = 1.00), local recurrence ( = 1.00), implant loss ( = 0.139), capsular contracture ( = 1.00), and nipple-areolar complex necrosis ( = 0.139). The BREAST-Q scores were equally high in both groups.
Our results suggest that inverted-T incision for ptotic breasts is a safe modality with similar complication rates and high aesthetic results compared with IMF incision for nonptotic breasts. A higher rate of nipple-areolar complex necrosis in the inverted-T group, although not significant, should be considered during careful preoperative planning and patient selection.
近年来，保留乳头的乳房切除术加乳房假体植入重建术因在美容和心理方面的益处有所改善而越来越受欢迎。然而，乳房下垂的患者仍然是外科医生面临的主要挑战，因为存在术后并发症的潜在风险。
对2017年3月至2021年11月期间接受保留乳头的乳房切除术和乳房前假体植入重建术的患者进行回顾性病历审查。比较了两个不同切口（乳房下垂患者采用倒T形切口，非乳房下垂患者采用乳房下皱襞切口）之间的患者人口统计学数据、并发症发生率以及使用BREAST-Q问卷评估的生活质量。
共检查了98例患者：乳房下皱襞组62例，倒T形组36例。结果表明两组在安全指标方面相当，包括血肿（p=0.367）、血清肿（p=0.552）、感染（p=1.00）、皮肤坏死（p=1.00）、局部复发（p=1.00）、假体丢失（p=0.139）、包膜挛缩（p=1.00）和乳头乳晕复合体坏死（p=0.139）。两组的BREAST-Q评分同样高。
我们的结果表明，对于乳房下垂患者，倒T形切口是一种安全的术式，与非乳房下垂患者的乳房下皱襞切口相比，并发症发生率相似，美学效果良好。在进行仔细的术前规划和患者选择时，应考虑倒T形组乳头乳晕复合体坏死率较高这一情况，尽管差异不显著。
