Nipple Position and Clinical Outcomes Following Nipple-Sparing Mastectomy: An Examination of Prepectoral and Subpectoral Implant-Based Reconstruction Utilizing 3D Imaging.
Carrie S Stern, Francis D Graziano, Donovan R White, Ronnie L Shammas, Ethan L Plotsker, Elizabeth Smith-Montes, Lillian Boe, Jacob Levy, Tracy-Ann Moo, Virgilio Sacchini, Robert J Allen, Babak J Mehrara, Jonas A Nelson
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引用次数: 0
Abstract
Background: Nipple-sparing mastectomy (NSM) has become increasingly popular in recent years. However, the impact of prepectoral vs subpectoral implant reconstruction on nipple position, clinical outcomes, and patient-reported outcomes (PROs) after NSM remains unknown.
Objective: We hypothesized that prepectoral reconstruction would lead to a more anatomic nipple position and improved clinical outcomes and PROs when compared to subpectoral reconstruction following NSM.
Methods: Surgical characteristics, complications, and PROs in NSM patients with implant-based reconstruction from 2018 to 2021 were prospectively collected. Nipple displacement from baseline was analyzed with 3-dimensional (3D) surface imaging.
Results: In total 216 patients underwent 391 NSMs, separated into subpectoral (n = 96) and prepectoral (n = 120) cohorts. There were no differences in demographics or comorbidities between cohorts. Prepectoral placement showed a greater incidence of short-term return to the operating room (21% vs 10%, P = .026). Three-dimensional analysis of 96 patients and 175 nipple positions was conducted. Compared to preoperative baseline, 3D imaging at 12 months postoperatively showed that the subpectoral cohort had greater straight-line distance between the nipples (23.1 mm vs 17.3 mm, P < .001) and more lateral nipple displacement (9.2 mm vs 6.1 mm, P < .001) when compared to the prepectoral cohort. Regression analysis found no relationship between incision pattern and nipple displacement. No postoperative differences were seen in PROs.
Conclusions: Subpectoral NSM reconstruction was found to have more lateralized nipple displacement when compared to prepectoral patients, regardless of the incision pattern employed. Nipple displacement after NSM can play a significant role in postoperative aesthetic appearance and should be considered when deciding implant plane.
背景：保留乳头乳房切除术（NSM）近年来越来越流行。然而，胸前与胸下植入物重建对乳头位置、临床结果和NSM后患者报告的结果（PROs）的影响尚不清楚。目的：我们假设与NSM后的胸下重建术相比，胸前重建术会导致更解剖的乳头位置，改善临床结果和PROs。方法：前瞻性收集2018 - 2021年NSM患者种植体重建的手术特点、并发症和PROs。使用三维（3D）表面成像分析乳头从基线位移。结果：216例患者接受了391例NSMs，分为胸下组（n = 96）和胸前组（n = 120）。队列之间的人口统计学和合并症没有差异。预选组的OR短期复发率更高（21% vs 10%, p=0.026）。对96例患者和175个乳头位置进行了三维分析。与术前基线相比，术后12个月的3D成像显示，胸下组患者乳头之间的直线距离更大（23.1 mm vs 17.3 mm）。结论：无论采用何种切口方式，与胸下NSM重建患者相比，胸下NSM重建患者乳头偏侧移位更多。NSM术后乳头移位对术后美观有重要影响，在确定种植平面时应予以考虑。
期刊介绍：
Aesthetic Surgery Journal is a peer-reviewed international journal focusing on scientific developments and clinical techniques in aesthetic surgery. The official publication of The Aesthetic Society, ASJ is also the official English-language journal of many major international societies of plastic, aesthetic and reconstructive surgery representing South America, Central America, Europe, Asia, and the Middle East. It is also the official journal of the British Association of Aesthetic Plastic Surgeons, the Canadian Society for Aesthetic Plastic Surgery and The Rhinoplasty Society.
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