scholarly journals The application of completion mastectomy and immediate reconstruction in a patient unable to undergo radiotherapy following breast conserving surgery: a case report

2021 ◽  
Vol 8 (8) ◽  
pp. 2428
Author(s):  
Emily Sawyer ◽  
Nita Bartlett ◽  
Simon Warry
Keyword(s):  
Breast Conserving Surgery ◽  
The Novel ◽  
Oncoplastic Breast Surgery ◽  
Immediate Reconstruction ◽  
Areolar Complex ◽  
Simple Mastectomy ◽  
Nipple Sparing Mastectomy ◽  
Nipple Sparing ◽  
Potential Use

Breast conserving surgery (BCS) with adjuvant radiotherapy (RT) confers an equivalent 20 year survival rate to mastectomy. Concerningly, 15% of BCS patients do not receive RT. Several barriers to completing RT have been described. However, non-compliance with post-BCS radiotherapy due to severe claustrophobia is not well documented in the literature. We report the case of a patient who declined radiotherapy following BCS due to severe claustrophobia. With advances in oncoplastic breast surgery, completion nipple-sparing mastectomy (NSM) may be an alternative to simple mastectomy in BCS patients unable to undergo RT. NSM is an oncoplastic procedure that involves attaining complete oncologic resection whilst sparing the nipple-areolar complex. Recent literature highlights that NSM has more favourable aesthetic outcomes and improves quality of life compared to simple mastectomy. This report further describes the novel use of NSM and reconstruction for the case patient and highlights its potential use in patients who are unable to undergo neoadjuvant RT.

Nipple-sparing mastectomy: Evaluation of oncologic safety and aesthetic outcomes in 94 patients.

2011 ◽  
Vol 29 (27_suppl) ◽  
pp. 97-97
Author(s):  
E. C. Millen ◽  
R. R. Pinto ◽  
L. Menezes ◽  
F. C. O. Almeida ◽  
G. Novita ◽  
...  
Keyword(s):  
Breast Conservation ◽  
Tissue Expander ◽  
Radical Mastectomy ◽  
Breast Conservation Therapy ◽  
Axillary Node ◽  
Tertiary Referral Hospital ◽  
Immediate Reconstruction ◽  
Areolar Complex ◽  
Nipple Sparing Mastectomy ◽  
Nipple Sparing

97 Background: The surgical treatment of breast cancer has evolved from radical mastectomy to breast conservation therapy. Today we have another therapeutic dilemma: how to manage the nipple-areolar complex (NAC) in mastectomy offering patients better aesthetic results with oncologic safety. Methods: We analyzed data on 125 consecutive nipple- or skin-sparing mastectomies (SSM) with immediate reconstruction with tissue expander, prosthesis or autologous tissue performed in 94 patients from 2003 to 2010 in a tertiary referral hospital. Nipple-sparing mastectomy (NSM) was performed for treatment disease (n= 94) and prophylaxis of contralateral breast or symmetrization in selected cases (n= 31). Results: Mean patients age was 46.8 years (range 27 to 69 years) and mean follow-up time was 27.2 months (range 2 weeks to 81 months). Twelve patients were stage 0, 41 stage I, 35 stage II A and B and 7 stage III. There were 125 nipple- or areola-sparing mastectomies (31 bilateral and 94 unilateral), including 112 NSM and 13 SSM. On pathologic review, 12 breasts had carcinoma in situ, 83 invasive carcinoma, and 31 breasts were cancer free. Thirteen nipples (13.8%) were compromised by tumor on subareolar biopsy and were removed. The location and type of incision was variable according to the tumor site and previous patient scar. Periareolar incision with prolongation along the inferior pole of breast was the preferred method. Patients with positive axillary node (27.5%) received adjuvant radiotherapy. There was no nipple necrosis. One patient presented local relapse in the skin-sparing group within 24 months. Conclusions: These data demonstrate that NSM is oncologically safe and can be performed with all types of breast reconstruction.

scholarly journals The Changing Face of Mastectomy (from Mutilation to Aid to Breast Reconstruction)

2011 ◽  
Vol 2011 ◽  
pp. 1-7 ◽  
Author(s):  
Stefano Zurrida ◽  
Fabio Bassi ◽  
Paolo Arnone ◽  
Stefano Martella ◽  
Andres Del Castillo ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Psychological Impact ◽  
Breast Conserving Surgery ◽  
Primary Treatment ◽  
Immediate Breast Reconstruction ◽  
The Past ◽  
Nipple Sparing Mastectomy ◽  
Nipple Sparing ◽  
New Skin

Breast cancer is the most common cancer in women. Primary treatment is surgery, with mastectomy as the main treatment for most of the twentieth century. However, over that time, the extent of the procedure varied, and less extensive mastectomies are employed today compared to those used in the past, as excessively mutilating procedures did not improve survival. Today, many women receive breast-conserving surgery, usually with radiotherapy to the residual breast, instead of mastectomy, as it has been shown to be as effective as mastectomy in early disease. The relatively new skin-sparing mastectomy, often with immediate breast reconstruction, improves aesthetic outcomes and is oncologically safe. Nipple-sparing mastectomy is newer and used increasingly, with better acceptance by patients, and again appears to be oncologically safe. Breast reconstruction is an important adjunct to mastectomy, as it has a positive psychological impact on the patient, contributing to improved quality of life.

scholarly journals Single Stage Nipple-Sparing Mastectomy and Reduction Mastopexy in the Ptotic Breast

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
M. E. Pontell ◽  
N. Saad ◽  
A. Brown ◽  
M. Rose ◽  
R. Ashinoff ◽  
...  
Keyword(s):  
Reduction Mammaplasty ◽  
Immediate Reconstruction ◽  
Areolar Complex ◽  
Increased Risk ◽  
History Of ◽  
Grade Ii ◽  
Ptotic Breasts ◽  
Nipple Sparing Mastectomy ◽  
Nipple Sparing ◽  
Grade Iii

Purpose. Given the proposed increased risk of nipple-areolar complex (NAC) necrosis, nipple-sparing mastectomy (NSM) is generally not recommended for patients with large or significantly ptotic breasts. NAC preserving strategies in this subgroup include staged or simultaneous NSM and reduction mastopexy. We present a novel approach towards simultaneous NSM and reduction mastopexy in patients with large, ptotic breasts. Methods. Literature pertaining to NSM for women with large, ptotic breasts was reviewed and a surgical approach was designed to allow for simultaneous NSM and reduction mastopexy in such patients. Results. Eight patients underwent bilateral NSM with simultaneous reduction mammaplasty and immediate reconstruction. The majority of breasts demonstrated advanced ptosis (69% grade III, 31% grade II) and the average breast volume excised was 760 grams. In those patients without a history of smoking, NAC necrosis rates were 0%. In those patients with a history of smoking, 83% of breasts experienced NAC necrosis (60% total, 40% partial). One hundred percent of patients who smoked experienced some degree of NAC necrosis. Among breasts with grade II versus grade III ptosis, NAC necrosis rates were roughly equal. Conclusions. Historically, patients with large, ptotic breasts were excluded from NSM due to the proposed increased risk of NAC necrosis. This study demonstrates a safe approach towards NSM and reduction mastopexy using an inferior, wide-based, epithelialized pedicle. While all patients eventually achieved satisfactory results, there was an association between smoking and NAC necrosis. Smoking cessation is paramount to the operation’s success.

Nipple-sparing mastectomy and immediate reconstruction: Indications, technique, and results of 110 patients with breast cancer

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 11088-11088
Author(s):  
B. Son ◽  
S. Ahn ◽  
H. Kim ◽  
M. Jang ◽  
E. Park ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Resection Margin ◽  
Breast Conserving Surgery ◽  
Immediate Reconstruction ◽  
Cosmetic Results ◽  
Oncological Safety ◽  
Tumor Involvement ◽  
Nipple Sparing Mastectomy ◽  
Nipple Sparing

11088 Background: Nipple-sparing mastectomy (NSM) and immediate reconstruction has recently been accepted as a new surgical procedure that provides good cosmetic results, although it is necessary to establish oncological safety. We reported our experience to evaluate indications, technique, results, and complications of NSM. Methods: Between 1999 and 2005, medical records of 113 patients with breast cancer undertaken NSM at the Asan Medical Center were analyzed retrospectively. Median age of the patients was 40 years and complications were assessed 3 months later postoperatively. Results: For preoperative indications of NSM, mulifocal or multicentric cancers were 60 cases (53.1%), diffuse microcalcifications on MMG were 27 cases (23.9%), failure of breast conserving surgery due to tumor involvement of resection margin were 12 cases (10.6%), central located small cancers were 11 cases (9.7%). Immediate reconstruction methods were 85 cases (75.2%) in TRAM and 28 cases (24.8%) in direct implant. Intraoperative frozen section biopsy for evaluation of tumor involvement at the NAC showed accuracy of 100%. Pathologic tumor size were 24 cases (21.2%) in Tis, 56 cases (49.6%) in T1, 33 cases (29.2%) in T2, respectively. Lymph node status showed 81 cases (71.7%) in N0, 24 cases (21.2%) in N1, 7 cases (6.2%), and one case (0.9%) in N3, respectively. During 20 months of the median follow-up, four patients developed recurrences; one local recurrence (subcutaneous), two (lung, brain) distant failures, and one local and distant failure. The rate of major NA necrotic complication was 14.6%, but all cases were improved with conservative management. 91.7% of patients were satisfied with their cosmetic results. Conclusions: Although the presented study does not establish conclusion with regard to oncological safety due to short follow-up period, the procedure of NSM with intraoperative pathologic assessment of the subareola tissue, and immediate reconstruction is a reasonable option for a selected patients. Good candidates for NSM are patients unsuitable for breast conservation either for multicentric or multofocal cancers, or because of extensive microcalcification, or involvement of resection margin during breast conserving surgery. No significant financial relationships to disclose.

The Safety of Operating on Breasts With a History of Prior Reduction Mammoplasty: Dynamic Magnetic Resonance Imaging Analysis of Angiogenesis

2021 ◽  
Author(s):  
Joseph Kyu-hyung Park ◽  
Seokwon Park ◽  
Chan Yeong Heo ◽  
Jae Hoon Jeong ◽  
Bola Yun ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Three Dimensional ◽  
Venous Drainage ◽  
Reduction Mammoplasty ◽  
Magnetic Resonance Images ◽  
Areolar Complex ◽  
Internal Mammary ◽  
Initial Procedure ◽  
Nipple Sparing Mastectomy ◽  
Nipple Sparing

Abstract Background Vascularity of the nipple-areolar complex (NAC) is altered after reduction mammoplasty, which increases complications risks after repeat reduction or nipple-sparing mastectomy. Objectives To evaluate angiogenesis of the NAC via serial analysis of breast magnetic resonance images (MRIs). Methods Breast MRIs after reduction mammoplasty were analyzed for 35 patients (39 breasts) using three-dimensional reconstructions of maximal intensity projection images. All veins terminating at the NAC were classified as internal mammary, anterior intercostal, or lateral thoracic in origin. The vein with the largest diameter was considered the dominant vein. Images were classified based on the time since reduction: <6 months, 6-12 months, 12-24 months, >2 years. Results The average number of veins increased over time: 1.17 (<6 months), 1.56 (6–12 months), 1.64 (12–24 months), 1.73 (>2 years). Within 6 months, the pedicle was the only vein. Veins from other sources began to appear at 6–12 months. In most patients, at least two veins were available after 1 year. After 1 year, the internal mammary vein was the most common dominant vein regardless of the pedicle used. Conclusions In the initial 6 months after reduction mammoplasty, the pedicle is the only source of venous drainage; however, additional sources are available after 1 year. The internal thoracic vein was the dominant in most patients. Thus, repeat reduction mammoplasty or nipple-sparing mastectomy should be performed ≥1 year following the initial procedure. After 1 year, the superior or superomedial pedicle may represent the safest option when the previous pedicle is unknown.

scholarly journals Robot-assisted Nipple-sparing Mastectomy with Immediate Breast Reconstruction: An Initial Experience

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Hyung Seok Park ◽  
Jeea Lee ◽  
Dong Won Lee ◽  
Seung Yong Song ◽  
Dae Hyun Lew ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Breast Reconstruction ◽  
Learning Curve ◽  
Operation Time ◽  
Immediate Breast Reconstruction ◽  
Robot Assisted ◽  
Open Conversion ◽  
Areolar Complex ◽  
Nipple Sparing Mastectomy ◽  
Nipple Sparing

Abstract Seeking smaller and indistinct incisions, physicians have attempted endoscopic breast surgery in breast cancer patients. Unfortunately, there are some limitations in the range of movement and visualization of the operation field. Potentially addressing these limitations, we investigated the outcomes of gas and gasless robot-assisted nipple-sparing mastectomy (RANSM) with immediate breast reconstruction (IBR). Ten patients underwent 12 RANSM with IBR between November 2016 and April 2018. Patients with tumors measuring >5 cm in diameter, tumor invasion of the skin or nipple-areolar complex, proven metastatic lymph nodes, or planned radiotherapy were excluded. Age, breast weight, diagnosis, tumor size, hormone receptor status, and operation time were retrospectively collected. Postoperative outcomes including postoperative complications and final margin status of resected were analyzed. The median total operation time and console time were 351 min (267–480 min) and 51 min (18–143 min), respectively. The learning curve presented as a cumulative sum graph showed that the console time decreased and then stabilized at the eighth case. There was no open conversion or major postoperative complication. One patient had self-resolved partial nipple ischemia, and two patients experienced partial skin ischemia. We deemed that RANSM with IBR is safe and feasible for early breast cancer, benign disease of the breast, and BRCA 1/2 mutation carriers. RANSM is an advanced surgical method with a short learning curve.

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