Dermal Nipple-Areola Complex Perfusion through Circumareolar Scars: A Delay Model in Two-Stage Nipple-Sparing Mastectomy.

Autor:	Tondu T; From the Department of Abdominal, Pediatric, and Reconstructive Surgery, Plastic Surgery Unit.; Multidisciplinary Breast Clinic, Unit of Gynecologic Oncology.; Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp., Jacobs C; Animal Research Facility., Vandevivere Y; Department of Anaesthesiology, AZ Monica., Verhoeven V; Department of Obstetrics and Gynecology., Tjalma W; Multidisciplinary Breast Clinic, Unit of Gynecologic Oncology.; Department of Obstetrics and Gynecology., Hubens G; From the Department of Abdominal, Pediatric, and Reconstructive Surgery, Plastic Surgery Unit.; Animal Research Facility., Blondeel P; Department of Plastic Surgery, Ghent University Hospital., De Greef K; Department of Hepatobiliary and Transplant Surgery, Antwerp University Hospital., Ysebaert D; Department of Hepatobiliary and Transplant Surgery, Antwerp University Hospital.; Animal Research Facility.
Jazyk:	angličtina
Zdroj:	Plastic and reconstructive surgery [Plast Reconstr Surg] 2023 Oct 01; Vol. 152 (4), pp. 797-805. Date of Electronic Publication: 2023 Mar 08.
DOI:	10.1097/PRS.0000000000010386
Abstrakt:	Background: Nipple-sparing mastectomy (NSM) has evolved as a standard surgical option. The NSM complication rate remains high in large breasts. To reduce the risk of necrosis, several authors have proposed delayed procedures to enhance blood supply to the nipple-areola complex (NAC). The purpose of this study in a porcine model was to show adequate redirection of NAC perfusion by neoangiogenesis through circumareolar scars. Methods: Delayed two-staged NSM was simulated in 52 nipples (six pigs) with a 60-day interval. The nipples underwent a full-thickness, circumareolar incision onto the muscular fascia, with preservation of underlying glandular perforators. After 60 days, NSM was performed through a radial incision. A silicone sheet was introduced in the mastectomy plane to prevent NAC revascularization by wound bed imbibition. Digital color imaging was used to assess necrosis. Near-infrared fluorescence with indocyanine green was used to assess perfusion patterns and perfusion in real time. Results: No NAC necrosis was seen after 60 days' delay in any nipples. In all nipples, indocyanine green angiography showed complete alteration of the NAC vascular perfusion pattern from subjacent gland to a capillary fill following devascularization, exhibiting a predominant arteriolar capillary blush without distinct larger vessels. Conclusions: NAC delay reverses glandular perfusion to adequate dermal neovascularization. Neovascularization through full-thickness scars provides sufficient dermal perfusion after 60 days' delay. Identical staged delay in humans may be a surgically safe NSM option and could broaden therapeutic NSM indications in difficult breasts. Large clinical trials are necessary to provide identical results in human breasts. Clinical Relevance Statement: NAC delay reverses glandular perfusion to adequate dermal neovascularization. Neovascularization through full-thickness scars provides sufficient dermal perfusion after 60 days of delay. Identical staged delay in humans may be a surgically safe NSM option. (Copyright © 2023 by the American Society of Plastic Surgeons.)
Databáze:	MEDLINE
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