Rache M Simmons1, Scott T Hollenbeck, Gregory S Latrenta. 1. Department of Surgery, New York Presbyterian Hospital, The Weill Medical College of Cornell University, 425 E. 61st St., 8th Floor, New York, NY 10021, USA. rms2002@med.cornell.edu
Abstract
OBJECTIVE: Areola-sparing mastectomy (ASM) is defined as resecting the nipple and any existing surgical biopsy scar, removing all breast parenchyma, and leaving a natural envelope of skin (including the areola), which improves the aesthetic result of immediate reconstruction. We previously demonstrated a <1% incidence of malignant involvement of the areola in a retrospective mastectomy series. Subsequently, we performed ASM on selected patients undergoing mastectomy. We report here our results from an ongoing study of ASM at our institution. METHODS: During a 20-month period, 17 ASMs with immediate reconstruction were performed on 12 patients. Patients were followed-up prospectively by the surgical oncologist for complications and recurrence. RESULTS: ASM was performed for breast cancer prophylaxis (n = 10), ductal carcinoma in situ (DCIS) (n = 4), and <2-cm peripheral infiltrating carcinoma (n = 3). The mean patient age was 47.7 years (range 37 to 61). Thirteen patients were reconstructed with tissue expanders and 4 with pedicle transverse rectus abdominus myocutaneous flaps. Ten patients underwent sentinel lymph node biopsy. None of the ten patients showed sentinel lymph node metastasis. Two patients with DCIS and microinvasion underwent subareolar touch-prep cytology, both of which were negative for malignancy. All mastectomy specimens had negative histologic margins. No patient received chemotherapy or radiation therapy. One postoperative consisted of a localized wound infection that resolved with oral antibiotics. At a median follow-up of 24 months (range 11 to 28), there were no instances of local or distant recurrence. CONCLUSIONS: Overall, we found that ASM with immediate reconstruction provides excellent aesthetic results with infrequent complications. Furthermore, in this small series we showed no recurrence at 2 years. We continue to offer ASM for selected patients including those desiring surgical breast cancer prophylaxis as well as those with DCIS or small peripheral infiltrating ductal carcinoma.
OBJECTIVE: Areola-sparing mastectomy (ASM) is defined as resecting the nipple and any existing surgical biopsy scar, removing all breast parenchyma, and leaving a natural envelope of skin (including the areola), which improves the aesthetic result of immediate reconstruction. We previously demonstrated a <1% incidence of malignant involvement of the areola in a retrospective mastectomy series. Subsequently, we performed ASM on selected patients undergoing mastectomy. We report here our results from an ongoing study of ASM at our institution. METHODS: During a 20-month period, 17 ASMs with immediate reconstruction were performed on 12 patients. Patients were followed-up prospectively by the surgical oncologist for complications and recurrence. RESULTS: ASM was performed for breast cancer prophylaxis (n = 10), ductal carcinoma in situ (DCIS) (n = 4), and <2-cm peripheral infiltrating carcinoma (n = 3). The mean patient age was 47.7 years (range 37 to 61). Thirteen patients were reconstructed with tissue expanders and 4 with pedicle transverse rectus abdominus myocutaneous flaps. Ten patients underwent sentinel lymph node biopsy. None of the ten patients showed sentinel lymph node metastasis. Two patients with DCIS and microinvasion underwent subareolar touch-prep cytology, both of which were negative for malignancy. All mastectomy specimens had negative histologic margins. No patient received chemotherapy or radiation therapy. One postoperative consisted of a localized wound infection that resolved with oral antibiotics. At a median follow-up of 24 months (range 11 to 28), there were no instances of local or distant recurrence. CONCLUSIONS: Overall, we found that ASM with immediate reconstruction provides excellent aesthetic results with infrequent complications. Furthermore, in this small series we showed no recurrence at 2 years. We continue to offer ASM for selected patients including those desiring surgical breast cancer prophylaxis as well as those with DCIS or small peripheral infiltrating ductal carcinoma.
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