Cavalcante Francisco P, Lima Ticiane O, Alcantara Ryane, Cardoso Amanda, Ulisses Flora, Novita Guilherme, Zerwes Felipe, Millen Eduardo
From Hospital Geral de Fortaleza, Fortaleza, Ceará, Brazil.
Instituto Oncoclínicas, São Paulo, São Paulo, Brazil.
Plast Reconstr Surg Glob Open. 2023 Nov 3;11(11):e5367. doi: 10.1097/GOX.0000000000005367. eCollection 2023 Nov.
Nipple-sparing mastectomy (NSM), either used therapeutically or prophylactically, may yield more complications than conventional mastectomy. The incision may affect aesthetic outcome and complication rates, with periareolar incisions being associated with nipple-areolar complex (NAC) necrosis.
Early complications were compared between NSM performed in 2015-2022 using inframammary fold (IMF) or periareolar incisions.
Overall, 180 procedures in 152 patients (bilateral NSM = 28) were included (IMF = 104; periareolar = 76). Mean age (47 versus 43.9 years; < 0.038), mastectomy weight (312.7 versus 246.8 grams; < 0.001), implant volume (447.5 versus 409.0 mL; = 0.002), and use of tissue expanders (68.4% versus 50.0%; = 0.013) were all greater with periareolar incisions. Prepectoral reconstruction was more common with IMF (18.3% versus 3.9%; = 0.004). Forty-three complications (23.9%) were recorded (periareolar n = 27, 35%; IMF n = 16, 15.3%; = 0.0002). NAC necrosis accounted for 17 complications (22.4%) in the periareolar group versus nine (8.5%) in the IMF group ( = 0.002). Necrosis was predominantly moderate (n = 6, 8.3% versus n = 1, 1.0%, respectively) ( = 0.014). Unadjusted odds ratios (OR) for complications [3.05; 95% confidence interval (CI): 1.27-7.26] and necrosis (3.04; 95% CI: 1.27-7.27) were higher in the periareolar group. In the multivariate analysis, necrosis was associated with periareolar incisions [adjusted odds ratio (aOR): 2.92; 95% CI: 1.14-7.44]. Prepectoral reconstruction was associated with IMF incisions (aOR: 25.51; 95% CI: 3.53-184.23; = 0.001) and with body mass index of more than 25-30 (aOR: 37.09; 95% CI: 5.95-231.10; < 0.001). Therapeutic mastectomies (aOR: 68.56; 95% CI: 2.50-188.36; = 0.012) and tissue expanders (aOR: 18.36; 95% CI: 1.89-178.44; = 0.026) were associated with seromas.
Both incisions are viable options; however, the risk of NAC necrosis increased with the periareolar approach. Further research is required.
保留乳头的乳房切除术（NSM），无论是用于治疗还是预防，可能比传统乳房切除术产生更多并发症。切口可能会影响美学效果和并发症发生率，乳晕周围切口与乳头乳晕复合体（NAC）坏死相关。
比较2015年至2022年采用乳房下皱襞（IMF）或乳晕周围切口进行的NSM的早期并发症。
总体而言，纳入了152例患者的180例手术（双侧NSM = 28例）（IMF = 104例；乳晕周围 = 76例）。乳晕周围切口组的平均年龄（47岁对43.9岁；P < 0.038）、乳房切除重量（312.7克对246.8克；P < 0.001）、植入物体积（447.5毫升对409.0毫升；P = 0.002）和组织扩张器的使用（68.4%对50.0%；P = 0.013）均更高。IMF切口组胸前重建更常见（18.3%对3.9%；P = 0.004）。记录到43例并发症（23.9%）（乳晕周围组n = 27例，35%；IMF组n = 16例，15.3%；P = 0.0002）。乳晕周围组NAC坏死占17例并发症（22.4%），而IMF组为9例（8.5%）（P = 0.002）。坏死主要为中度（分别为n = 6例，8.3%对n = 1例，1.%;P = 0.014）。乳晕周围组并发症[3.05；95%置信区间（CI）：1.27 - 7.26]和坏死（3.04；95% CI：1.27 - 7.27）的未调整优势比（OR）更高。在多变量分析中，坏死与乳晕周围切口相关[调整后优势比（aOR）：；95% CI：1.14 - 7.44]。胸前重建与IMF切口相关（aOR：25.51；95% CI：3.53 - 184.23；P = 0.001），与体重指数超过25 - 30相关（aOR：37.09；95% CI：5.95 - 231.10；P < 0.001）。治疗性乳房切除术（aOR：68.56；95% CI：2.50 - 188.36；P = 0.012）和组织扩张器（aOR：18.36；95% CI：1.89 - 178.44；P = 0.026）与血清肿相关。
两种切口都是可行的选择；然而，乳晕周围入路会增加NAC坏死的风险。需要进一步研究。
