Tomas Maciulaitis, Daiva Gudavicienė, Nerijus Jakutis
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引用次数: 0
Abstract
Background: Nipple-sparing mastectomy (NSM) with immediate implant-based reconstruction is widely accepted and effective prophylactic surgical approach for women with high-risk of hereditary BC. However, anatomical factors-advanced breast ptosis and increased sternal notch-to-nipple (SN-N) distance-can increase technical difficulty and complication risk. Preshaping procedures may optimize anatomy and broaden NSM eligibility. This study evaluates the role of preshaping in facilitating safe NSM with implant-based reconstruction.
Methods: We conducted a retrospective analysis of 84 patients who underwent prophylactic mastectomy at Vilnius University Hospital Santaros Klinikos between 2018 and 2024. All had confirmed pathogenic mutations associated with hereditary BC risk. At the time of analysis, 76 patients had completed mastectomy, while 8 had undergone only the preshaping procedure. Patients were divided into two cohorts: single-stage NSM with direct-to-implant reconstruction, and a two-stage approach involving initial preshaping surgery followed by delayed NSM. Anatomical features, surgical timing, complications were analyzed.
Results: Among 76 patients, 63.2% underwent single-stage and 36.8% two-stage reconstruction. Two-stage patients had significantly greater SN-N distances (26.4 ± 3.1 cm vs. 21.6 ± 3.2 cm, p < 0.001). The overall complication rate was 7.9%, higher in the single-stage group (10.4%) than the two-stage group (3.6%). In the single-stage cohort, complications correlated with higher ptosis grades (p = 0.0021). Ductal carcinoma in situ was found in one patient from each group.
Conclusions: Preshaping surgery effectively optimizes anatomy for NSM, reducing complications in patients with ptosis or extended SN-N distances. The two-stage approach offers safe and favorable outcomes in anatomically challenging cases.
背景：保留乳头乳房切除术（NSM）即刻植体重建是遗传性BC高危女性广泛接受的有效预防性手术方法。然而，解剖学上的因素——乳房下垂晚期和胸骨切口到乳头（SN-N）距离增加——会增加技术难度和并发症的风险。预成型程序可以优化解剖学和扩大NSM的资格。本研究评估了预成型在促进NSM安全种植重建中的作用。方法：回顾性分析2018年至2024年在维尔纽斯大学医院Santaros Klinikos行预防性乳房切除术的84例患者。所有人都证实了与遗传性BC风险相关的致病性突变。在分析时，76例患者完成了乳房切除术，而8例仅进行了预成型手术。患者被分为两组：单阶段NSM直接植入重建和两阶段方法，包括初始预成型手术和延迟NSM。分析解剖特征、手术时机、并发症。结果：76例患者中，63.2%行一期重建，36.8%行二期重建。两期患者的SN-N距离明显增大（26.4±3.1 cm vs. 21.6±3.2 cm, p p = 0.0021）。两组各有1例导管原位癌。结论：预成形手术有效地优化了NSM的解剖结构，减少了上睑下垂或延长SN-N距离患者的并发症。两阶段入路在解剖困难的病例中提供了安全和有利的结果。
期刊介绍：
Evidence of surgical interventions go back to prehistoric times. Since then, the field of surgery has developed into a complex array of specialties and procedures, particularly with the advent of microsurgery, lasers and minimally invasive techniques. The advanced skills now required from surgeons has led to ever increasing specialization, though these still share important fundamental principles.
Frontiers in Surgery is the umbrella journal representing the publication interests of all surgical specialties. It is divided into several “Specialty Sections” listed below. All these sections have their own Specialty Chief Editor, Editorial Board and homepage, but all articles carry the citation Frontiers in Surgery.
Frontiers in Surgery calls upon medical professionals and scientists from all surgical specialties to publish their experimental and clinical studies in this journal. By assembling all surgical specialties, which nonetheless retain their independence, under the common umbrella of Frontiers in Surgery, a powerful publication venue is created. Since there is often overlap and common ground between the different surgical specialties, assembly of all surgical disciplines into a single journal will foster a collaborative dialogue amongst the surgical community. This means that publications, which are also of interest to other surgical specialties, will reach a wider audience and have greater impact.
The aim of this multidisciplinary journal is to create a discussion and knowledge platform of advances and research findings in surgical practice today to continuously improve clinical management of patients and foster innovation in this field.
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