Breast Centre, West China Hospital, Sichuan University, Chengdu, China.
Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China.
Ann Surg Oncol. 2024 Apr;31(4):2777-2785. doi: 10.1245/s10434-023-14687-7. Epub 2024 Feb 9.
Minimal access breast surgery improves cosmetic outcomes over conventional breast surgery but still faces barriers in becoming standard procedure for breast reconstruction. This report introduces a novel technique of transaxillary reverse-sequence endoscopic nipple-sparing mastectomy (R-E-NSM) followed by direct-to-implant prepectoral breast reconstruction (DTI-PBR) and describes its clinical outcomes.
This prospective study enrolled patients who underwent R-E-NSM and DTI-PBR from March 2021 to December 2021 at a single institution. Perioperative data, surgical complications, oncologic outcomes, and patient- and surgeon-reported cosmetic results were noted.
The 60 patients in this study who underwent 68 R-E-NSM and DTI-PBR had a mean age was 40.4 ± 10.3 years. The average durations of uni- and bilateral operations were 156.5 ± 48.3 min and 191.3 ± 36.1 min, respectively. The overall surgical complication rate was 13.3%, including 10.0% of patients with minor complications and 3.3% of patients with major complications. The study had one case (1.7%) of implant loss and one case (1.7%) of skin flap necrosis treated by reoperation. During the median follow-up period of 24 months, one patient (1.7%) who discontinued chemotherapy for myelosuppression experienced liver metastases 5 months postoperatively, and one patient experienced new-onset contralateral ductal carcinoma in situ 24 months postoperatively. The preoperative and 18-month postoperative Breast-Q scores for satisfaction with breasts, psychosocial well-being, sexual well-being, and chest well-being did not differ significantly, and the Scar-Q was 81.2 ± 14.5 points. The good-to-excellent rate in surgeon-reported cosmetic results reached 90%.
Transaxillary R-E-NSM followed by DTI-PBR is a safe and efficient technique with high cosmetic outcomes and reliable medium-term oncologic results.
微创乳房手术相较于传统乳房手术在美容效果上有所改善，但在成为乳房重建的标准手术方面仍面临障碍。本报告介绍了一种新的经腋窝反序内镜乳头保留乳房切除术（R-E-NSM）联合直接置管胸肌前置乳房重建术（DTI-PBR）的技术，并描述了其临床结果。
本前瞻性研究纳入了 2021 年 3 月至 2021 年 12 月在一家单中心接受 R-E-NSM 和 DTI-PBR 的患者。记录围手术期数据、手术并发症、肿瘤学结果以及患者和外科医生报告的美容结果。
本研究共纳入 60 例患者，共进行了 68 例 R-E-NSM 和 DTI-PBR，平均年龄为 40.4 ± 10.3 岁。单侧和双侧手术的平均时间分别为 156.5 ± 48.3 分钟和 191.3 ± 36.1 分钟。总的手术并发症发生率为 13.3%，包括 10.0%的患者出现轻微并发症和 3.3%的患者出现严重并发症。研究中有 1 例（1.7%）患者发生了假体丢失，1 例（1.7%）患者发生了皮瓣坏死，需要再次手术治疗。在中位随访 24 个月期间，1 例（1.7%）因骨髓抑制而停止化疗的患者在术后 5 个月发生肝转移，1 例患者在术后 24 个月发生新发性对侧导管原位癌。术前和 18 个月时的乳房 Q 评分在乳房满意度、心理社会健康、性健康和胸部满意度方面没有显著差异，瘢痕 Q 评分为 81.2 ± 14.5 分。外科医生报告的美容效果的良好至优秀率达到 90%。
经腋窝 R-E-NSM 联合 DTI-PBR 是一种安全有效的技术，具有较高的美容效果和可靠的中期肿瘤学结果。
