Guo Xuhui, Gong Xilong, Yang Yue, Wang Lina, Hou Lei, Zhang Jiao, Zhao Yajie, Wang Jia, Dai Hao, Jiao Dechuang, Liu Zhenzhen
Department of Breast disease, Henan Breast Cancer Center, Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Dongming Road, Zhengzhou, Henan Province, 450008, China.
Department of Reconstructive and Plastic Surgery, Peking University Shougang Hospital, Beijing, 100000, China.
BMC Cancer. 2025 Oct 16;25(1):1592. doi: 10.1186/s12885-025-15058-z.
Nipple-sparing mastectomy (NSM) with autologous tissue reconstruction offers excellent cosmetic outcomes but can be complicated by skin necrosis. This study aimed to investigate the risk factors for skin necrosis after NSM with deep inferior epigastric perforator (DIEP) flap reconstruction, focusing on the impact of circumferential periareolar incision length.
A retrospective review of 61 patients who underwent NSM followed by DIEP flap reconstruction between 2020 and 2023 was conducted. Data on patient demographics, breast characteristics, incision type, and skin necrosis outcomes were collected.
The overall rate of the mastectomy skin flap or nipple-areola complex (NAC) was 42.6%. The length of the periareolar incision was significantly associated with the incidence of skin necrosis (p = 0.035). Patients with incisions exceeding 30% of the periareolar circumference had a higher risk of necrosis (57.1%) compared to those with shorter incisions (30.3%). No significant associations were found between skin necrosis and BMI, breast ptosis, patient age, year of reconstruction, or neoadjuvant chemotherapy.
This study suggests that for patients undergoing NSM with DIEP flap reconstruction, a circumferential periareolar incision length exceeding 30% is associated with an increased risk of skin necrosis in the mastectomy skin flap or NAC. Surgeons should strive to minimize periareolar incision length while ensuring adequate access for flap vascular anastomosis.
保留乳头的乳房切除术（NSM）联合自体组织重建可带来出色的美容效果，但可能会并发皮肤坏死。本研究旨在探讨采用腹壁下深动脉穿支（DIEP）皮瓣重建的NSM术后皮肤坏死的危险因素，重点关注乳晕周围环形切口长度的影响。
对2020年至2023年间接受NSM并随后进行DIEP皮瓣重建的61例患者进行回顾性研究。收集了患者人口统计学、乳房特征、切口类型和皮肤坏死结果的数据。
乳房切除皮瓣或乳头乳晕复合体（NAC）的总体发生率为42.6%。乳晕周围切口的长度与皮肤坏死的发生率显著相关（p = 0.035）。乳晕周长超过30%的切口患者发生坏死的风险（57.1%）高于切口较短的患者（30.3%）。未发现皮肤坏死与BMI、乳房下垂、患者年龄、重建年份或新辅助化疗之间存在显著关联。
本研究表明，对于接受NSM联合DIEP皮瓣重建的患者，乳晕周围环形切口长度超过30%会增加乳房切除皮瓣或NAC皮肤坏死的风险。外科医生应在确保皮瓣血管吻合有足够操作空间的同时，努力将乳晕周围切口长度减至最短。
