Expanding the Use of Nipple-Sparing Mastectomies in Obese Patients Undergoing Staged Implant-Based Reconstruction

Background: Advantages of various mastectomy techniques include skin reduction and favorable aesthetics in Wise-pattern closures, and less visible scars in nipple-sparing mastectomies (NSM). This study compares postoperative complication profiles between Wise-pattern and nipple-sparing mastectomies in the obese population. Methods: A retrospective chart review of obese patients (BMI ≥ 30) who underwent staged breast reconstruction following Wise-pattern and nipple-sparing mastectomies at our institution between February 2016 and January 2020 was conducted. Complications between cohorts were analyzed using the independent samples t-test (2-sided) and the χ2 test. Results: A total of 232 breasts (163 Wise-pattern, 69 NSM) were re-constructed in 123 obese female patients (85 Wise-pattern, 38 NSM). Complication rates in both the Wise-pattern and NSM patient cohorts were similar following stage 1 (Wise-pattern: 30.7%, NSM: 39.1%, p = 0.212) and stage 2 (Wise-pattern: 16.6%, NSM: 15.9%, p = 0.907) of reconstruction. No statistically significant differences in rates of infection, dehiscence, seroma, hematoma or malposition of tissue expander (TE)/implant following stage 1 or stage 2 were found between cohorts. Conclusions: There were no significant differences in postoperative complication rates between the Wise-pattern and NSM cohorts of obese patients. NSM can be a viable surgical option in carefully selected obese patients and offer the advantage of concealed scarring.

The Place of Nipple-Sparing Mastectomy in the Treatment of Breast Cancer: Review of the Literature

Introduction: Mastectomy with conservation of the nipple-areola complex (NAC) in breast cancer care has been controversial with regards to the oncological safety of this procedure and the risk of complications including NAC necrosis. Aim: The objective of this study is to assess, through a literature review, the safety and reliability of a conservative NAC mastectomy in breast cancer treatment, paying attention to the rate of local recurrence and complications. Methods: A review of the literature was conducted from PubMed data, and articles published between January 2007 and December 2017, using the terms “nipple-sparing mastectomy”, “breast cancer”, “local recurrence”, “necrosis of the nipple”, “global complications”. The articles were analyzed with regards to the following parameters of evaluation: local recurrence, recurrence rate at NAC level, global complication rates and nipple necrosis rates. Results: In the 36 studies we selected, the average rate of local recurrence was 3.23%. The average rate of recurrence at the NAC was 0.81%. The average rate of complications was 20%. The average rate of necrosis of the NAC was 5.9%. The main factors of these recurrences were the tumor size > 5 cm and tumor stage > stage II. Conclusion: Conservative mastectomy of the nipple-areola complex offers an aesthetic advantage and oncological safety in carefully selected patients with breast cancer.

Immediate nipple-areola-sparing mastectomy reconstruction: An update on oncological and reconstruction techniques

Nipple-sparing mastectomy(NSM) is a safe technique in patients who are candidates for conservation breast surgery. However, there is worry concerning its oncological safety and surgical outcome in terms of postoperative complications. The authors reviewed the literature to evaluate the oncological safety, patient selection, surgical techniques, and also to identify the factors influencing postoperative outcome and complication rates. Patient selection and safety related to NSM are based on oncological and anatomical parameters. Among the main criteria, the oncological aspects include the clinical stage of breast cancer, tumor characteristics and location including small, peripherally located tumors, without multicentricity, or for prophylactic mastectomy. Surgical success depends on coordinated planning with the oncological surgeon andcareful preoperative and intraoperative management. In general, the NSM reconstruction is related to autologous and alloplastic techniques and sometimes include contra-lateral breast surgery. Choice of reconstructive technique following NSM requires accurate consideration of various patient related factors, including: breast volume, degree of ptosis, areola size, clinical factors, and surgeon's experience. In addition, tumor related factors include dimension, location and proximity to the nipple-areola complex. Regardless of the fact that there is no unanimity concerning the appropriate technique, the criteria are determined by the surgeon's experience and the anatomical aspects of the breast. The positive aspects of the technique utilized should include low interference with the oncological treatment, reproducibility, and long-term results. Selected patients can have safe outcomes and therefore this may be a feasible option for early breast cancer management. However, available data demonstrates that NSM can be safely performed for breast cancer treatment in selected cases. Additional studies and longer follow-up are necessary to define consistent selection criteria for NSM.

Nipple-Areola Sparing Mastectomy Followed by Immediate Breast Reconstruction in 126 Patients

This study is to explore the indications, procedures, effectiveness, and feasibility of nipple-areola sparing mastectomy followed by immediate breast reconstruction. The nipple-areola sparing mastectomy followed by immediate breast reconstruction was performed in 126 patients with breast cancer from June 2005 to October 2011. The cosmetic outcomes of the reconstructed breasts were evaluated according to objective and subjective criteria. Meanwhile, the postoperative complications were observed and the therapeutic efficacies were followed up. All the operations were successful. Six patients experienced mild complications early after surgery and were resolved after symptomatic treatment. Both the subjective and objective evaluation for the aesthetic outcomes yielded a satisfactory rate of 97.62% during the 6-80-month follow-up. No recurrence or metastasis was found in 118 cases. Nipple-areola sparing mastectomy followed by immediate breast reconstruction is a simple and effective option for significantly improving the cosmetic outcomes and quality of life of patients, without serious complications or impact on the comprehensive treatment and long-term effect against breast cancer.

单孔腔镜保留乳头乳晕全乳切除术在早期乳腺癌中的应用效果探讨

目的探讨单孔腔镜保留乳头乳晕全乳切除术在早期乳腺癌中的应用效果。方法选取2021年7月至2022年8月于广西壮族自治区人民医院行保留乳头乳晕全乳切除术的40例患者,其中行单孔腔镜下保留乳头乳晕全乳切除术者20例(腔镜组),开放保留乳头乳晕全乳切除术者20例(开放组)。比较两组手术时间、术中出血量、切口长度、术后住院时间、术后引流量、并发症发生率,以及术后6个月的乳腺癌生存质量测评量表(FACT-B)评分和美容效果满意度评分等。结果两组患者均顺利完成手术并康复出院。腔镜组切口长度短于开放组,但手术时间长于开放组,术后引流量多于开放组,差异有统计学意义(P<0.05)。腔镜组术后6个月FACT-B测评量表评分和美容效果满意度评分高于开放组,差异有统计学意义(P<0.05)。两组术中出血量、术后住院时间、术后并发症发生率比较差异无统计学意义(P>0.05)。结论单孔腔镜下保留乳头乳晕全乳切除术安全有效,具有更好的美容效果和患者满意度,可提高患者的生活质量和心理健康。

Nipple-sparing Mastectomy in Breast Cancer： From an Oncologic Safety Perspective

Objective：To evaluate the oncologic safety of nipple-sparing mastectomy （NSM） for breast cancer patients based on current literature.Data Sources：A comprehensive literature search ofMedline,Embase databases was conducted for studies published through March 2014.Study Selection：Our search criteria included English-language studies that focused on NSM at nipple-areola complex （NAC） involvement,patient selection,and recurrence.Prophylaxis NSM,case series or reports that based on very small population were excluded.In the end,42 studies concerning NSM and oncological safety were included into the review.Results：NSM is a surgical procedure that allows the preservation of the skin and NAC in breast cancer patients or in patients with prophylactic mastectomy.However,the oncologic safety and patient selection criteria associated with NSM are still under debate.The incidence of NAC involvement of breast cancer in recent studies ranges from 9.5% to 24.6%,which can be decreased through careful patient selection.Tumour-nipple distance,tumour size,lymph node involvement and molecular characteristics can be evaluated preoperatively by clinical examinations,imaging studies and biopsies to predict the risk of NAC involvement.Currently,there is no available standard protocol for surgical approaches to NSM or pathological examination of NSM specimens.The local recurrence （ranges from 0% to 24%） of NSM is not significantly higher than that of traditional mastectomy in selected patients based on long-term follow-up.The role of radiotherapy in NSM is still controversial and is not universally accepted.Conclusions：NSM appears to be oncologically safe following careful patient selection and assessment of margins.

Investigation of the current situation of nipple-sparing mastectomy:a large multicenter study in China(CSBrs-003)

Background:Mastectomy techniques have been extended to nipple-sparing mastectomy(NSM).This study aimed to assess the actual application of NSM in China and identify the factors influencing postoperative complications.Methods:The clinical data of 615 patients(641 surgeries)undergoing NSM from January 1st,2018 to December 31st,2018 at 28 centers nationwide were retrospectively analyzed to obtain the rate of NSM and investigate factors related to NSM surgery.Results:The proportion of NSM surgery performed in this study was 2.67%(17/641).Malignant breast tumors accounted for the majority of NSM surgery(559/641,87.2%).A total of 475(77.3%)patients underwent NSM combined with reconstructive surgery.The rate of reconstruction decreased with age in our study,and implants were the most common option(344/641,53.7%)in reconstruction.Radial incision was the most selected method regardless of reconstruction.However,for those who underwent reconstruction surgery,18.4%(85/462)of cases also chose curvilinear incision,while in the simple NSM surgery group,more patients chose circumareolar incision(26/136,19.1%).The tumor-to-nipple distance(TND)influenced postoperative complications(P=0.004).There were no relationships between postoperative complications and tumor size,tumor location,histologic grade,molecular subtype,nipple discharge,and axillary lymph nodes.Conclusions:NSM surgery is feasible and only TND influenced postoperative complications of NSM surgery.But the proportion of NSM surgery performed is still low in nationwide centers of China.The selection criteria for appropriate surgical methods are important for NSM in clinical practice.To optimize clinical applications of NSM,further multicenter prospective randomized controlled studies are needed.

保留乳头乳晕乳腺癌术后即刻乳房再造15例

目的探讨保留乳头乳晕乳腺癌改良根治术后即刻采用背阔肌乳房再造的可行性。方法 2007年5月~2010年1月,对15例年龄为31~45岁（平均38岁）的乳腺癌患者行保留乳头乳晕乳腺癌改良根治术后即刻采用背阔肌乳房再造。对手术时间、术后并发症和美学效果进行评估。结果平均手术时间270 min,再造乳房全部成活,无严重的并发症发生。美容效果优良13例、尚好2例,无外形差的病例。5例术后出现背部供区血清肿,2例乳头部分坏死。术后所有患者对乳房形态均满意。结论对早期乳腺癌行保留乳头乳晕乳腺癌改良根治术后即刻采用背阔肌乳房再造是可行的。该方法操作简便,术后并发症少,再造乳房形态良好,它同时满足了肿瘤治疗和形体美容两个方面的要求,是早期乳腺癌患者一种安全有效的手术方式。

保留乳头乳晕改良根治术治疗早期乳腺癌的效果分析

目的:探讨保留乳头乳晕改良根治术(NSM)治疗早期乳腺癌(EBC)的效果。方法:选取113例EBC患者,按照随机数字表法分为对照组56例和干预组57例。对照组给予传统乳腺癌改良根治术(MRM)治疗,干预组57例给予NSM治疗。对比两组手术情况、乳房美容效果、免疫功能和激素水平。结果:两组淋巴结清扫数目、手术时间比较差异无统计学意义(P>0.05),干预组住院时间短于对照组,术后引流量少于对照组(P<0.05);干预组美容优良率94.74%高于对照组80.36%(P<0.05);术后1个月,两组血清FT3、FT4水平较术前升高,且干预组高于对照组(P<0.05);术后1 d,两组CD3~+、CD4~+、CD4~+/CD8~+水平较术前降低,干预组高于对照组(P<0.05)。结论:NSM治疗EBC患者可改善手术情况和免疫功能,也有良好的乳房美容效果。

成年女性正常乳头的超声观察

目的:观察成年女性正常乳头的二维超声表现及多普勒特征,探讨乳头超声检查的临床应用价值。方法:超声检查成年女性的531例正常乳头,其中左乳头282个,右乳头249个,根据年龄分为青年组(29个)、中青年组(128个)、中年组(287个)、老年组(87个),观察乳头的声像图特点,记录每个乳头的大小(左右径、前后径)、血流分级以及血流频谱参数,包括阻力指数(RI)、峰值流速(Vmax)及舒张末期流速(Ved)。结果:531例乳头的回声形态各异,乳头的左右径、前后径平均值分别为(13.0±2.3)mm、(9.3±1.5)mm,左右两侧之间差异无统计学意义;不同年龄组之间差异有统计学意义。9%的乳头无血流信号,乳头的血流分级在左右两侧及各年龄组之间均无明显差异(P﹥0.05)。RI在左右两侧乳头的差异无统计学差异,在不同年龄组之间有统计学差异;Vmax、Ved在左右两侧乳头之间存在差异,在各年龄组之间无明显差异。结论:乳头的大小和阻力指数可随年龄动态变化;乳头超声发现无明显血流的乳头在评估保留乳房乳晕复合体乳房切除术后乳头坏死有一定的价值。