Kook Yoonwon, Kim Dooreh, Park Soeun, Chu Chihhao, Jang Ji Soo, Baek Seung Ho, Bae Soong June, Ahn Sung Gwe, Jeong Joon
Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine.
Institute for Breast Cancer Precision Medicine, Yonsei University College of Medicine.
Int J Surg. 2024 Dec 1;110(12):7791-7797. doi: 10.1097/JS9.0000000000002155.
Nipple-sparing mastectomy (NSM) aims to improve patient satisfaction by preserving the nipple-areola complex (NAC) while ensuring oncologic safety. Different surgical incisions, such as inframammary fold (IMF) and periareolar/radial incisions, are used in NSM; however, their impact on NAC sensory loss remains unclear. In this study, the authors aimed to assess NAC sensation after NSM and compare the results of different incisional approaches, specifically IMF versus periareolar/radial.
In this prospective, single-center, nonrandomized controlled trial, 105 post-NSM patients were recruited from October 2019 to November 2021 and followed up at 24-48 months postsurgery. Of these, 97 (IMF: 65; periareolar/radial: 32) were analyzed for sensory assessment. NAC sensation was measured using the pin-prick test, with scores ranging from 0 (no sensation) to 2 (sharp sensation) across five NAC areas. Sensory loss was defined as a total score below 3.
The median total score on the pin-prick test for NAC sensation was significantly higher in the IMF incision group than in the periareolar/radial incision group (3.77±3.11 vs. 2.47±2.51; P=0.043). The rate of NAC sensory loss was significantly lower in the IMF group than in the periareolar/radial group (36.9% vs. 62.5%; P=0.017). Multivariable analysis revealed that the incisional approach (95% CI: 0.14-0.97; P=0.044) and radiotherapy (95% CI: 0.05-0.36; P<0.01) were independent determinants of NAC sensory loss.
Our study emphasized the importance of incision placement during NSM in preserving NAC sensation and may provide a valuable perspective for clinicians and patients considering this surgical approach.
保留乳头的乳房切除术（NSM）旨在通过保留乳头乳晕复合体（NAC）来提高患者满意度，同时确保肿瘤学安全性。NSM中使用了不同的手术切口，如乳房下皱襞（IMF）切口和乳晕周围/放射状切口；然而，它们对NAC感觉丧失的影响仍不清楚。在本研究中，作者旨在评估NSM后NAC的感觉，并比较不同切口方式的结果，特别是IMF切口与乳晕周围/放射状切口的结果。
在这项前瞻性、单中心、非随机对照试验中，2019年10月至2021年11月招募了105例NSM术后患者，并在术后24-48个月进行随访。其中，97例（IMF切口：65例；乳晕周围/放射状切口：32例）进行了感觉评估。使用针刺试验测量NAC感觉，在五个NAC区域的评分范围为0（无感觉）至2（刺痛感）。感觉丧失定义为总分低于3分。
IMF切口组NAC感觉针刺试验的中位数总分显著高于乳晕周围/放射状切口组（3.77±3.11对2.47±2.51；P=0.043）。IMF组NAC感觉丧失率显著低于乳晕周围/放射状组（36.9%对62.5%；P=0.017）。多变量分析显示，切口方式（95%CI：0.14-0.97；P=0.044）和放疗（95%CI：0.05-0.36；P<0.01）是NAC感觉丧失的独立决定因素。
我们的研究强调了NSM手术中切口位置对保留NAC感觉的重要性，并可能为考虑这种手术方法的临床医生和患者提供有价值的参考。
