关键词: 乳头乳晕复合体, 保留NAC乳癌改良根治术

Abstract: Objective To summarize the effect and experience of preserving nipple-areola complex （NAC） in radical mastectomy for breast cancer. Methods Female patients who underwent surgical treatment for breast cancer in our hospital from March 2018 to March 2021 were selected. The inclusion criteria included that the primary tumor was located outside the areola and the tumor was more than 2 cm away from the areolar edge. A total of 99 patients were enrolled, including 45 patients who underwent nipple-sparing mastectomy （NSM） （NSM group） and 44 patients who underwent standard mastectomy （standard group）. The clinical effects including the sensory recovery of NAC after operation were observed after NSM. The postoperative pathological characteristics and complications between the patients with and without preservation of NAC were compared. Results Preoperative examination:there was no significant difference between the two groups in age, NAC diameter, nipple distance from tumor, preoperative tumor stage, type, tumor location and number of multiple lesions （P > 0.05）. Postoperative pathology in NSM group:35 cases （77.8%） were invasive carcinoma, 10 cases （22.2%） were ductal carcinoma in situ, the median tumor size was 2.4 cm （0.2~4.1 cm）, and axillary lymph node metastasis was found in 5 cases; In standard group, 37 cases （84.1%） were invasive carcinoma, 7 cases （15.9%） were carcinoma in situ, the median tumor size was 2.6 cm （0.2~4.7） cm, and 7 cases were axillary lymph node metastasis. There were 12 cases of fat liquefaction and seroma in each group, and 2 cases of slight wound infection in each group, which healed after conservative treatment. There were 8 cases of nipple or areolar necrosis in the NAC preservation group, of which 7 cases were small part necrosishealed after conservative treatment, and one case required NAC excision due to nipple necrosis. In addition, there were 3 cases and 5 cases of flap necrosis in NSM group and standard group respectively, all of which were healed by conservative treatment. Among the patients with NSM, 3（7.3%） had complete areola sensation recovery, 18（43.9%） had partial recovery, 20 had no sensation, and the nipple sensation recovery was the worst. Only one patient had postoperative nipple sensation sensitivity. The postoperative satisfaction of the two groups was similar. Conclusion Nipple-sparing mastectomy is feasible and has good cosmetic effect, but nipple sensitivity following NSM was markedly diminished.

Key words: nipple-areola complex, nipple-sparing mastectomy