Sağır Mehmet, Güven Erdem, Saylik Onur, Dülgeroğlu Onur, Uras Cihan
Specialist in Department of Plastic Surgery, Private Acibadem Maslak Hospital, 34457, Sarıyer, Istanbul, Turkey.
Department of General Surgery, Acibadem Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Turkey.
Aesthetic Plast Surg. 2024 Dec;48(23):4965-4972. doi: 10.1007/s00266-024-04115-w. Epub 2024 May 20.
In this study, a lateralized parabolic multiplanar incision was defined. It was aimed to reduce necrosis in the nipple-areola complex (NAC) and, in the long run, to prevent the scar from pulling the areola laterally by maintaining healthy skin tissue between the scar and the areola and preserving the natural round appearance of the areola. Moreover, we purposed the scar not to be visible from the anterior view.
The study included 243 patients who underwent nipple-sparing mastectomy and immediate implant-based breast reconstruction. The incision was made 4-5 cm away from the lateral border of the NAC. The incision was completed after passing the anterior axillary line by drawing a parabolic curve in superolateral axis.
The mean follow-up period was 24.6 months, and the mean age of the patients was 42.3 years. Full-thickness necrosis of the NAC occurred in 3.6% of breasts. In long-term follow-ups, the incision scar measured an average length of 8.6 cm. None of the patients had lateral displacement of the NAC. The NAC preserved its round appearance, except for 12 breasts that had full-thickness NAC necrosis. Ten breasts had an unnatural breast appearance.
The lateralized parabolic multiplanar incision is an ideal incision model for nipple-sparing mastectomy, as it allows for the exposure and reconstruction of all breast quadrants. We maintain areolar circulation; there are no visible scars when viewed anteriorly. Furthermore, it prevents lateral displacement of the NAC, ensuring that the natural round form of the NAC is not distorted.
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在本研究中，定义了一种外侧抛物线多平面切口。其目的是减少乳头乳晕复合体（NAC）的坏死，从长远来看，通过在瘢痕和乳晕之间保留健康的皮肤组织并保持乳晕自然的圆形外观，防止瘢痕将乳晕向外侧牵拉。此外，我们希望从正面看不到瘢痕。
该研究纳入了243例行保留乳头的乳房切除术及即刻植入式乳房重建术的患者。切口在距NAC外侧缘4 - 5 cm处进行。通过在superolateral轴上绘制抛物线，经过腋前线后完成切口。
平均随访期为24.6个月，患者平均年龄为42.3岁。3.6%的乳房发生了NAC全层坏死。在长期随访中，切口瘢痕平均长度为8.6 cm。没有患者出现NAC向外侧移位。除12例发生NAC全层坏死的乳房外，NAC均保持其圆形外观。10例乳房外观不自然。
外侧抛物线多平面切口是保留乳头的乳房切除术的理想切口模型，因为它允许暴露和重建所有乳腺象限。我们维持乳晕血液循环；从正面看没有可见瘢痕。此外，它可防止NAC向外侧移位，确保NAC自然的圆形形态不被扭曲。
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