保留皮肤的全乳切除术和一期乳房再造

Skin-sparing mastectomy and immediate breast reconstruction

保乳手术为乳腺癌病人提供了保留乳房的机会，但仍有病人达不到保乳条件而行全乳切除者。术后一期再造可以满足病人的美容要求。随着乳房切除术后一期再造的开展，对再造乳房的外形美观要求也大大上升。保留皮肤的全乳切除术（skin-sparing mastectomy SSM）灵活选择切口，合理选择对象，不仅在切除全部乳腺的同时最大程度保留皮肤，达到根治性目的；而且并不会因为保留皮肤而提高局部复发率，也不对生存有影响。一些一期再造病人适合行SSM以达到治疗和美容的双重效果。再此基础上，保留乳头或保留乳晕的全乳切除术（nipple-sparing mastectomy NSM或areola-sparing mastectomy ASM）也得到了应用。

Breast-conserving surgery made it possible to keep breast for some breast cancer patients, however, some ones could not achieve such qualifications for conservation. Breast constructive surgery offers a chance to recover an aesthetic contour for breast cancer patients after mastectomy. With the development of reconstruction, skin-sparing mastectomy （SSM）, which had the features such as retaining enough breast skin, resection all mammary, obtaining good cosmetic outcome and no increase of local recurrence even overall survival, is developed for immediate reconstruction. Thus, SSM achieves both therapeutic and cosmetic effects. On the basis of SSM, the other modalities such as nipple-sparing mastectomy and areola-sparing mastectomy are used for some selected patients.