Nipple sparing mastectomy pdf download

Study of NSM demonstrating the recent evolution in the practice of NSM with expanded indications in terms of patient characteristics, tumor stage, prior surgery and radiation concomitant with decrease in complication rates. Increasing eligibility for nipple-sparing mastectomy. When mastectomy is needed: is the nipple-sparing procedure a new standard with very few contraindications? J Surg Oncol. Preoperative predictors of nipple-areola complex involvement for patients undergoing mastectomy for breast cancer.

Expanding the indications for total skin-sparing mastectomy: is it safe for patients with locally advanced disease? Nipple-sparing mastectomy in patients with previous breast surgery. Outcomes and feasibility of nipple-sparing mastectomy for node-positive breast cancer patients.

J Natl Cancer Inst. Total skin-sparing mastectomy in BRCA mutation carriers. Nipple-sparing mastectomy for breast cancer and risk-reducing surgery: the Memorial Sloan-Kettering Cancer Center experience.

Nipple sparing mastectomy: can we predict the factors predisposing to necrosis? Total skin-sparing mastectomy: complications and local recurrence rates in 2 cohorts of patients.

Outcomes after total skin-sparing mastectomy and immediate reconstruction in breasts. Nipple-sparing mastectomy: initial experience at the memorial sloan-kettering cancer center and a comprehensive review of literature. Breast J. Additive risk of tumescent technique in patients undergoing mastectomy with immediate reconstruction.

Use of tumescent mastectomy technique as a risk factor for native breast skin flap necrosis following immediate breast reconstruction. Intraoperative imaging of nipple perfusion patterns and ischemic complications in nipple-sparing mastectomies. An outcome analysis of intraoperative angiography for postmastectomy breast reconstruction. Aesthet Surg J. Using intraoperative laser angiography to safeguard nipple perfusion in nipple-sparing mastectomies.

Christin A. Harless; Steven R. The Breast. Effects of nitroglycerin ointment on mastectomy flap necrosis in immediate breast reconstruction: a randomized controlled trial. Radiotherapy in implant-based immediate breast reconstruction: risk factors, surgical outcomes, and patient-reported outcome measures in a large Swedish multicenter cohort.

Breast Cancer Res Treat. Nipple-sparing mastectomy in irradiated breasts: selecting patients to minimize complications. Risk factors associated with recurrence after nipple-sparing mastectomy for invasive and intraepithelial neoplasia.

Ann Oncol. Skin and nipple-areola complex sparing mastectomy in breast cancer patients: year experience. The role of nipple-sparing mastectomy in breast cancer: a comprehensive review of the literature. Long-term follow-up of nipple-sparing mastectomy without radiotherapy: a single center study at a Japanese institution.

Additional follow-up data are cancer, who decide to undergo prophylactic surgery, and for now required both to determine the long-term local recur- patients with small and peripherally located tumors, who are rence rate for NSM performed with different indications and candidates for breast-conserving therapy but prefer mastec- to assess the cosmetic outcome achieved by advanced surgical tomy. However, the range of indications for NSM might be techniques.

Recent findings regarding neoplastic involvement of the NAC and current advances in surgical techniques have Conflict of Interest led to the question of whether NAC preservation is feasible even in patients with large tumors close to the NAC and mul- The authors declare no conflicts of interest. Plast Reconstr Surg nipple-sparing mastectomy: terminal duct lobular Nipple-sparing mastectomy: critical assessment of ;— Ann Surg Oncol ;— Cancer ;— Int Semin Surg compared with non-skin-sparing mastectomies.

Am J Surg ;— Breast Do H: Skin-sparing mastectomy and immediate ment in peripheral breast carcinoma: a prospective Cancer Res Treat ;— Indian J Cancer ;—5. J Am Coll Surg ;— Am J Surg struction is an oncologically safe procedure.

Surg ;— Breast areola complex involvement in breast cancer motome biopsy of ducts beneath the nipple areola Cancer Res Treat ;— Ann complex. Eur J Surg Oncol ;— Plast Reconstr Surg ; tion and clinical determinants. Plast Reconstr Surg mastectomy. Br J Surg ;— Arch Surg ;— Plast Reconstr Surg Transplant Bull up.

J Plast Reconstr the nipple-areola skin: broadening the indications. Aesthetic Plast Surg ;— Aesthet Surg ;— Ann Surg ;— Cancer ;— tomy for primary operable breast cancer. Br J Surg and areola in carcinoma of the breast. Ann Surg Breast Cancer Res Treat ;— Surg value. Accepted for publication May 20, All rights reserved.

With proper eligibility criteria for patients undergoing NSM, NAC relapses are very rare, for which the finding of negative retroareolar margin is paramount for oncologic NSM protocol safety 2,3, Moreover, the requirement of the axillary direction. The surgeon left a flap with approximately 0. Alfredo Barros Clinic. Subsequently, all patients underwent immediate breast reconstruction via silicone implants placed in a submuscular pocket. Simultaneous mastopexy was performed in women with glandular ptosis, in whom the NAC had migrated and was centralized in the breast mound.

After surgery, the entire specimen was submitted to routine paraffin embedding and reanalyzed microscopically for DERM. IND were solely examined using paraffin sections. Eventual positive findings at the retroareolar margin or at the intra-nipple ducts in the definitive analyses indicated NAC removal in a second-step surgical procedure.

Data analysis To evaluate the confidence in IERM, its predictive capacity in relation to that of DERM was estimated based on sensitivity, specificity, predictive positive value, negative predictive value, and accuracy.

False negative rates of IERM were calculated first for the whole casuistic, and afterward separately for invasive and ductal in situ cases. Frequency analysis of the intra- nipple ducts involvement in cases of clear intraoperative or postoperative evaluation of the retroareolar margin was also estimated. Results Subjects and disease characteristics Figure 2 Intra-nipple duct removal.

A central bundle was excised A total of patients with cancer-bearing breasts were with a fine-end knife as a separate specimen. Mean patient margin. Tables 1,2 show the histopathologic and molecular data of retroareolar margin DERM , the frozen section fragments the patients.

If the subtypes were as follows: invasive not otherwise specified margin was negative, the NAC was preserved. The margins cases Precursor lesions such as atypical ductal micropapillary carcinoma 4 cases 2.

The NAC was immediately excised apocrine differentiation 1 case each 0. The subtypes among the DCIS cases included: cribriform Following gland removal, the nipple was inverted, and 20 cases Estrogen receptor Positive Negative 24 Overall, 2. Negative 29 Figures 3,4 show clean and involved retroareolar margins on paraffin sections.

Clearness of the negative IERM 1. All lesions occurred in IBC retroareolar margin was confirmed in patients No case of malignancy inside the nipple- in the definitive paraffin-embedded tissue sections. In the ducts was detected among the 44 patients with DCIS. Clear Accuracy Ultimately, NAC was removed in 10 of symbolic and psychologic significance However, cases 4.

NSM for BC treatment, NAC-sparing surgeries should be recommended with caution owing to concerns regarding proper case selection and oncologic outcomes 7,8,16, For example, Wu et al. Retroareolar margin and nipple ducts in NSM of breast tissue while achieving low morbidity, and the best possible cosmetic results, is not simple.

Ann Surg Oncol. Article Google Scholar. Quality-of-life outcomes improve with nipple-sparing mastectomy and breast reconstruction. Plast Reconstr Surg. A comparison of patient-reported outcomes after nipple-sparing mastectomy and conventional mastectomy with reconstruction. Nipple-sparing and skin-sparing mastectomy: review of aims, oncological safety and contraindications. Recurrence outcomes after nipple-sparing mastectomy and immediate breast reconstruction in patients with pure ductal carcinoma in situ.

Tumor-to-nipple distance as a predictor of nipple involvement: expanding the inclusion criteria for nipple-sparing mastectomy.

Oncologic safety of nipple-sparing mastectomy in patients with short tumor-nipple distance. Breast J. Oncologic outcomes of nipple-sparing mastectomy with immediate breast reconstruction in patients with tumor-nipple distance less than 2.

J Breast Cancer. Tumor-to-nipple distance should not preclude nipple-sparing mastectomy in breast cancer patients. Personal experience and literature review. Anticancer Res. Expanded indications and improved outcomes for nipple-sparing mastectomy over time. Overall survival, disease-free survival, local recurrence, and nipple-areolar recurrence in the setting of nipple-sparing mastectomy: a meta-analysis and systematic review. Breast cancer recurrence in the nipple-areola complex after nipple-sparing mastectomy with immediate breast reconstruction for invasive breast cancer.