Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
Department of Plastic Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
Am Surg. 2024 Nov;90(11):2769-2779. doi: 10.1177/00031348241250039. Epub 2024 Apr 26.
Nipple-sparing mastectomy (NSM) with deep inferior epigastric perforator (DIEP) flap reconstruction is a surgical option for select patients with or at risk of breast cancer. However, post-operative skin flap and nipple-areolar complex (NAC) necrosis remain common complications. This study aimed to identify factors associated with necrosis in patients undergoing NSM with DIEP reconstruction.
A retrospective cohort study was performed from 2015 to 2023. 74 variables were analyzed in patients undergoing NSM with DIEP. Patients were stratified into 3 groups based on post-operative skin/NAC necrosis: none, partial thickness, and full thickness. Comparative and descriptive statistics were performed via t-tests, ANOVA, and chi-squared tests.
34 women with 31 breast cancers met inclusion. 44% experienced necrosis: 15% partial thickness and 29% full thickness. The majority were white (85.3%) with mean age of 50 years (SD = 9.11). In patients with immediate DIEP reconstruction, hypoperfused areas identified by SPY angiography increased risk of necrosis ( = .012). Approximately 50% of both partial thickness and full thickness necrosis patients had concerns on SPY angiography. Former smokers in the full thickness necrosis group had more pack years than those without necrosis (9 vs .65 pack years, = .035).
In patients receiving NSM with DIEP flap reconstruction, those with hypoperfusion on SPY angiography and longer smoking history had higher necrosis rates. This supports the continued used of SPY angiography and the role of pre-operative counseling in former smokers with increased pack years on their risk of necrosis and the role of preventative measures in the perioperative setting.
保留乳头的乳房切除术（NSM）联合腹壁下动脉穿支皮瓣（DIEP）重建是一种选择性手术，适用于有或有乳腺癌风险的患者。然而，术后皮瓣和乳头乳晕复合体（NAC）坏死仍然是常见的并发症。本研究旨在确定与接受 NSM 联合 DIEP 重建的患者坏死相关的因素。
回顾性队列研究于 2015 年至 2023 年进行。对 74 例接受 NSM 联合 DIEP 的患者进行了分析。根据术后皮肤/NAC 坏死情况，将患者分为 3 组：无坏死、部分厚度坏死和全厚度坏死。通过 t 检验、方差分析和卡方检验进行比较和描述性统计。
31 例乳腺癌的 34 名女性符合纳入标准。44%的患者发生坏死：15%为部分厚度坏死，29%为全厚度坏死。大多数患者为白人（85.3%），平均年龄为 50 岁（标准差=9.11）。在接受即时 DIEP 重建的患者中，SPY 血管造影术确定的低灌注区域增加了坏死的风险（ =.012）。约 50%的部分厚度和全厚度坏死患者对 SPY 血管造影术有顾虑。全厚度坏死组的前吸烟者吸烟年限较无坏死组长（9 年与 0.65 年， =.035）。
在接受 NSM 联合 DIEP 皮瓣重建的患者中，SPY 血管造影术显示低灌注和吸烟史较长的患者坏死发生率较高。这支持继续使用 SPY 血管造影术，并支持对有较高吸烟年限的前吸烟者进行术前咨询，以了解其坏死风险，以及在围手术期采取预防措施的作用。
