Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
Division of Plastic Surgery, Institute for Reconstructive Surgery, Department of Surgery, Houston Methodist Hospital, Houston, TX, USA.
J Plast Reconstr Aesthet Surg. 2024 Apr;91:249-257. doi: 10.1016/j.bjps.2024.02.042. Epub 2024 Feb 9.
Staged nipple-sparing mastectomy (NSM) following mastopexy or breast reduction has become increasingly utilized in patients with large or ptotic breasts. The safety and efficacy of this approach has been demonstrated in recent years. However, the optimal timing between stages has not been established. The authors provide their experience with this staged approach with emphasis on timing between stages. An institutional review board approved this retrospective study. Data of all patients at a single institution who underwent staged NSM following mastopexy or reduction mammaplasty for therapeutic or prophylactic oncologic surgical management from 2016 to 2020 were reviewed. Timing between stages as well as surgical, oncologic, aesthetic, and patient-reported outcomes were evaluated. Nineteen patients (38 breasts) underwent staged NSM following planned mastopexy/breast reduction. The mean time interval between stages was 25 weeks. No patients developed nipple areolar complex necrosis. Infection and hematoma were seen in one breast (2.6%) and seroma in two (5.3%) after NSM. Delayed wound healing was seen in eight breasts (21.1%) after first stage mastopexy/reduction and in 12 breasts (31.6%) after NSM. Skin flap necrosis was noted in two breasts (5.3%) after NSM. No patients developed oncological recurrence. Mean patient-reported post-operative satisfaction and well-being scores were 63 and 67 out of 100, respectively. The authors describe their experience with staged NSM following nipple repositioning procedures. Their results suggest that this procedure can be performed safely with cosmetically favorable results if surgeons wait an average of 25 weeks between first and second stage procedures.
分期保留乳头乳晕的乳房切除术（NSM）在乳房较大或下垂的患者中应用越来越广泛。近年来，这种方法的安全性和有效性已得到证实。然而，各阶段之间的最佳时机尚未确定。作者提供了他们在这种分期方法方面的经验，重点是各阶段之间的时机。本回顾性研究获得机构审查委员会批准。对 2016 年至 2020 年期间，在一家机构接受分期 NSM 的所有患者数据进行了回顾，这些患者因治疗或预防性肿瘤外科管理的需要，在接受乳房提升或乳房缩小术的基础上行分期 NSM。评估了各阶段之间的时机以及手术、肿瘤学、美学和患者报告的结果。19 名患者（38 个乳房）在计划的乳房提升/乳房缩小术后接受了分期 NSM。各阶段之间的平均时间间隔为 25 周。没有患者发生乳头乳晕复合体坏死。NSM 后有 1 个乳房（2.6%）出现感染和血肿，2 个乳房（5.3%）出现血清肿。第一阶段乳房提升/缩小术后 8 个乳房（21.1%）和 NSM 后 12 个乳房（31.6%）出现延迟愈合。NSM 后有 2 个乳房（5.3%）出现皮瓣坏死。没有患者发生肿瘤学复发。患者报告的术后满意度和幸福感平均得分为 63 和 67（满分 100）。作者描述了他们在乳头定位手术后进行分期 NSM 的经验。他们的结果表明，如果外科医生在第一阶段和第二阶段之间等待平均 25 周，该手术可以安全进行，且美容效果良好。
