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A Novel Approach to the Management of Margin-positive DCIS in Nipple-sparing Mastectomy.

Becker H, Billington ME - Plast Reconstr Surg Glob Open (2014)

Bottom Line: Revision through a direct vertical nipple incision allowed for adequate surgical revision and pathologic evaluation of the retroareolar breast tissue while maintaining the nipple-areola skin and primary mastectomy incision.This novel approach ensures negative margins, allows superior cosmetic outcome, and improves patient autonomy in decision making.The technique may translate to NSM patients with positive retroareolar margins or false-negative margins.

View Article: PubMed Central - PubMed

Affiliation: Florida Atlantic University College of Medicine, Boca Raton, Fla.

ABSTRACT

Summary: Nipple-sparing mastectomy (NSM) is gaining acceptance as an oncologically sound and cosmetically superior mastectomy technique. Debate exists over the management of positive margins near the nipple-areola complex. This case report presents a novel approach to the management of margin-positive ductal carcinoma in situ in NSM. A 50-year-old white female with invasive ductal carcinoma underwent NSM. Intraoperative pathology indicated the presence of DCIS-positive retroareolar margins. Revision through a direct vertical nipple incision allowed for adequate surgical revision and pathologic evaluation of the retroareolar breast tissue while maintaining the nipple-areola skin and primary mastectomy incision. This novel approach ensures negative margins, allows superior cosmetic outcome, and improves patient autonomy in decision making. The technique may translate to NSM patients with positive retroareolar margins or false-negative margins.

No MeSH data available.


Related in: MedlinePlus

Closure of the right nipple after tissue removal: the nipple has been reapproximated with good cosmetics and nipple viability noted.
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Figure 3: Closure of the right nipple after tissue removal: the nipple has been reapproximated with good cosmetics and nipple viability noted.

Mentions: For optimal management, we elected to retain the nipple skin while removing any residual breast glandular tissue via direct vertical incision of the NAC. Vertical incision was chosen to minimize disruption of blood flow to the nipple. An incision was made through the NAC to the acellular dermal matrix (Fig. 2). The base of the NAC was excised and submitted for frozen section. Next, all remaining glandular tissue was excised from the medial and lateral margins of the NAC, leaving only skin. Frozen section results for all specimens were negative. A drain was placed in the pocket and brought out through the skin; platelet rich plasma was placed in the pocket, and the incision was closed with 5-0 interrupted nylon sutures (Fig. 3).


A Novel Approach to the Management of Margin-positive DCIS in Nipple-sparing Mastectomy.

Becker H, Billington ME - Plast Reconstr Surg Glob Open (2014)

Closure of the right nipple after tissue removal: the nipple has been reapproximated with good cosmetics and nipple viability noted.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4255896&req=5

Figure 3: Closure of the right nipple after tissue removal: the nipple has been reapproximated with good cosmetics and nipple viability noted.
Mentions: For optimal management, we elected to retain the nipple skin while removing any residual breast glandular tissue via direct vertical incision of the NAC. Vertical incision was chosen to minimize disruption of blood flow to the nipple. An incision was made through the NAC to the acellular dermal matrix (Fig. 2). The base of the NAC was excised and submitted for frozen section. Next, all remaining glandular tissue was excised from the medial and lateral margins of the NAC, leaving only skin. Frozen section results for all specimens were negative. A drain was placed in the pocket and brought out through the skin; platelet rich plasma was placed in the pocket, and the incision was closed with 5-0 interrupted nylon sutures (Fig. 3).

Bottom Line: Revision through a direct vertical nipple incision allowed for adequate surgical revision and pathologic evaluation of the retroareolar breast tissue while maintaining the nipple-areola skin and primary mastectomy incision.This novel approach ensures negative margins, allows superior cosmetic outcome, and improves patient autonomy in decision making.The technique may translate to NSM patients with positive retroareolar margins or false-negative margins.

View Article: PubMed Central - PubMed

Affiliation: Florida Atlantic University College of Medicine, Boca Raton, Fla.

ABSTRACT

Summary: Nipple-sparing mastectomy (NSM) is gaining acceptance as an oncologically sound and cosmetically superior mastectomy technique. Debate exists over the management of positive margins near the nipple-areola complex. This case report presents a novel approach to the management of margin-positive ductal carcinoma in situ in NSM. A 50-year-old white female with invasive ductal carcinoma underwent NSM. Intraoperative pathology indicated the presence of DCIS-positive retroareolar margins. Revision through a direct vertical nipple incision allowed for adequate surgical revision and pathologic evaluation of the retroareolar breast tissue while maintaining the nipple-areola skin and primary mastectomy incision. This novel approach ensures negative margins, allows superior cosmetic outcome, and improves patient autonomy in decision making. The technique may translate to NSM patients with positive retroareolar margins or false-negative margins.

No MeSH data available.


Related in: MedlinePlus