Yolanda Ho-Yan Chan1, Wai-Ming Yau1, Polly Suk-Yee Cheung2. 1. Department of Surgery, Kwong Wah Hospital, 25 Waterloo Road, Kowloon, Hong Kong SAR. 2. Breast Care Centre, Hong Kong Sanatorium and Hospital, 2 Village Road, Happy Valley, Hong Kong SAR. pollyc@pca.hk.
Abstract
BACKGROUND: Nipple-sparing mastectomy (NSM) has gained widespread popularity in recent years. Nonetheless, patient selection, technical consideration and oncological safety of its extension to breast cancer treatment remain uncertain. Few publications have reviewed the application of NSM in Asian populations. METHODS: We retrospectively reviewed 91 women with malignant breast tumours, who underwent 97 NSM in Hong Kong Sanatorium and Hospital from 2009 to 2015. Breast cancer patients who required mastectomy and opted for immediate reconstruction were considered for NSM if they showed no obvious nipple involvement clinically. All breast specimens were subjected to intraoperative pathological examination of the retroareolar tissue to exclude occult tumour infiltration before the final decision of nipple-areola complex (NAC) preservation. Clinical parameters, tumour characteristics and oncological outcomes were analyzed. RESULTS: Carcinoma of the breast accounts for 99.0% of our indications for therapeutic NSM. Almost all NSM were accompanied with immediate reconstruction. Abnormal pathology was shown in retroareolar tissue of ten patients (10.3%), and seven of these NAC were excised due to tumour involvement detected by intraoperative frozen section. Six (6.2%) NSM were complicated with superficial epidermolysis. Yet, there was no delayed NAC excision because of nipple necrosis. Overall NAC preservation rate reached 92.8%. Local and/or distant recurrences occurred in four patients (4.1%) after a mean follow-up of 20.6 months. One NAC recurrence was documented. CONCLUSION: Our series support the oncological safety of NSM after exclusion of neoplastic NAC involvement preliminarily by intraoperative frozen section and definitively by final pathology. Its technical feasibility is well proven by the low nipple necrosis rate.
BACKGROUND: Nipple-sparing mastectomy (NSM) has gained widespread popularity in recent years. Nonetheless, patient selection, technical consideration and oncological safety of its extension to breast cancer treatment remain uncertain. Few publications have reviewed the application of NSM in Asian populations. METHODS: We retrospectively reviewed 91 women with malignant breast tumours, who underwent 97 NSM in Hong Kong Sanatorium and Hospital from 2009 to 2015. Breast cancerpatients who required mastectomy and opted for immediate reconstruction were considered for NSM if they showed no obvious nipple involvement clinically. All breast specimens were subjected to intraoperative pathological examination of the retroareolar tissue to exclude occult tumour infiltration before the final decision of nipple-areola complex (NAC) preservation. Clinical parameters, tumour characteristics and oncological outcomes were analyzed. RESULTS:Carcinoma of the breast accounts for 99.0% of our indications for therapeutic NSM. Almost all NSM were accompanied with immediate reconstruction. Abnormal pathology was shown in retroareolar tissue of ten patients (10.3%), and seven of these NAC were excised due to tumour involvement detected by intraoperative frozen section. Six (6.2%) NSM were complicated with superficial epidermolysis. Yet, there was no delayed NAC excision because of nipple necrosis. Overall NAC preservation rate reached 92.8%. Local and/or distant recurrences occurred in four patients (4.1%) after a mean follow-up of 20.6 months. One NAC recurrence was documented. CONCLUSION: Our series support the oncological safety of NSM after exclusion of neoplastic NAC involvement preliminarily by intraoperative frozen section and definitively by final pathology. Its technical feasibility is well proven by the low nipple necrosis rate.
Authors: Markus Niemeyer; Stefan Paepke; Rainer Schmid; Birgit Plattner; Daniel Müller; Marion Kiechle Journal: Breast J Date: 2011-03-31 Impact factor: 2.431
Authors: F Caruso; M Ferrara; G Castiglione; G Trombetta; L De Meo; G Catanuto; G Carillio Journal: Eur J Surg Oncol Date: 2006-07-07 Impact factor: 4.424
Authors: Virgilio Sacchini; José A Pinotti; Alfredo C S D Barros; Alberto Luini; Alfonso Pluchinotta; Marianne Pinotti; Marcelo G Boratto; Marco D Ricci; Carlos A Ruiz; Antonio C Nisida; Paolo Veronesi; Jean Petit; Paolo Arnone; Fabio Bassi; Joseph J Disa; Carlos A Garcia-Etienne; Patrick I Borgen Journal: J Am Coll Surg Date: 2006-09-11 Impact factor: 6.113
Authors: Artur Bocian; Piotr Kędzierawski; Krzysztof Kurczych; Przemysław Jasnowski; Daniel Maliszewski; Agnieszka Kołacińska Journal: Prz Menopauzalny Date: 2020-10-02