Positive Nipple Margin After Nipple-Sparing Mastectomy: An Alternative and Oncologically Safe Approach to Preserving the Nipple–Areolar Complex

Haslinger, Michelle; Sosin, Michael; Bartholomew, Alex J.; Crocker, Andrew; Gulla, Aistė; Willey, Shawna C.; Pittman, Troy A.; Tousimis, Eleni

doi:10.1245/s10434-018-6569-4

Cited by 16 publications

(10 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Eleven patients (34.4%) were treated with subareolar shave biopsies to achieve negative margins. Final pathologies after shave biopsy did not reveal residual disease, and these patients did not develop necrosis of the NAC with no recurrence at a mean follow-up of 3.2 years; thus, the study writers concluded that subareolar shave biopsy is a safe alternative to preserving the NAC 15 …”

Section: Discussionmentioning

confidence: 80%

“…Final pathologies after shave biopsy did not reveal residual disease, and these patients did not develop necrosis of the NAC with no recurrence at a mean follow-up of 3.2 years; thus, the study writers concluded that subareolar shave biopsy is a safe alternative to preserving the NAC. 15 de Alcantara Filho et al 14 reported a 3.1% nipple positivity rate after NSM, with 2.3% being invasive carcinoma. Jensen et al 16 reported a rate of 15% of NSMs having invasive carcinoma on subareolar frozen tissue biopsy.…”

Section: Discussionmentioning

confidence: 96%

“…Disease recurrence was 0% at a mean follow-up of 3.2 years. 15 Thus, the incidence of positive nipple margins remains variable in the literature-between 3% and 21%. There is currently no discrete correlation with tumor-to-nipple distance or other discrete factors and margin positivity.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Immediate Nipple Reconstruction With Areolar Flaps After Nipple Excision

Sanchez,

Bloomquist,

Wright

et al. 2023

Ann Plast Surg

View full text Add to dashboard Cite

Nipple-sparing mastectomies (NSMs) have become a common surgical approach in the management of invasive breast cancers and ductal carcinoma in situ, and as a risk-reducing approach in genetically predisposed patients. The current standard of care in the management of positive nipple margin after NSM is total excision of the nipple-areola complex. In this article, we aimed to present a case series describing a novel approach to positive nipple margins with nipple-only excision and immediate nipple reconstruction using areolar flaps in patients who underwent NSM for noninvasive tumors. We conducted a retrospective review of patients who underwent NSM and were found to have positive nipple margins and underwent subsequent nipple excision with immediate areolar flap reconstruction. We identified 6 patients who underwent NSM and were found to have nipple margins—5 for ductal carcinoma in situ and 1 for invasive ductal carcinoma. These patients underwent nipple excision with immediate reconstruction using “sickle” flaps. We concluded that if nipple excision and immediate reconstruction with areolar sickle flaps can be performed, it results in good aesthetic outcomes without compromising oncologic results.

show abstract

Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 96%

See 1 more Smart Citation

Immediate Nipple Reconstruction With Areolar Flaps After Nipple Excision

Sanchez,

Bloomquist,

Wright

et al. 2023

Ann Plast Surg

View full text Add to dashboard Cite

show abstract

“…However, our study suggests that NSM is oncologically safe even when a patient's TND is < 2.0 cm. With the increased rate of NSM use in breast cancer, several studies have compared the oncologic safety profile of this technique with that of others [1617]. Gerber et al [1] reported no significant differences in complications between NSM, SSM, and modified radical mastectomy.…”

Section: Discussionmentioning

confidence: 99%

Oncologic Outcomes of Nipple-Sparing Mastectomy with Immediate Breast Reconstruction in Patients with Tumor-Nipple Distance Less than 2.0 cm

et al. 2019

View full text Add to dashboard Cite

PurposeAlthough the indications for nipple-sparing mastectomy (NSM) are expanding, there remains a debate regarding the oncologic outcomes of patients treated with this method, especially those with a short tumor–nipple distance (STND). The aim of this study was to compare the long-term oncologic outcomes between patients with a long tumor–nipple distance (LTND) (≥ 2.0 cm) and those with STND (< 2.0 cm).MethodsThis was a retrospective study in which 266 patients who underwent NSM with immediate breast reconstruction between January 2008 and December 2014 at a single institution were enrolled. Of these patients, 21 were excluded because of loss to follow-up; thus, 245 patients were finally analyzed. All patients underwent preoperative breast magnetic resonance imaging and intraoperative frozen biopsy.ResultsThe mean age of the patients was 42.4 years. STND was identified in 128 patients, and LTND in 117 patients. The mean follow-up period was 60.5 months. There were no significant differences between the 2 groups with respect to lymphovascular invasion, nuclear grade, nodal status, and subtype (p = 0.339, 0.372, 0.955, and 0.338, respectively). The STND group had significantly smaller tumors than the LTND group (p = 0.005). The median TND in the STND and LTND groups was 0.7 cm and 3.0 cm, respectively. Locoregional recurrence was reported in 4 patients in the STND group (3.1%) and 6 (5.1%) in the LTND group. A total of 3 patients died (1.2%; 2 in the STND group and one in the LTND group). There was no significant difference between the 2 groups with respect to disease-free survival or local recurrence-free survival (p = 0.334 and p = 0.477, respectively).ConclusionThe long-term oncologic outcomes of patients treated with NSM did not significantly differ according to TND when the intraoperative frozen biopsy was negative for tumor cells.

show abstract

“…An increasing number of patients choose breast-conserving surgery, which could lead to more positive incision margins during the operation. [8][9][10] Therefore, the positive incision margin during operation has attracted increased attention.…”

Section: Introductionmentioning

confidence: 99%

The Delivery Materials with Chemotherapy Drugs for Treatment of the Positive Margin in Solid Tumors

Zhu

Liu

Feng

et al. 2020

Tissue Engineering Part A

View full text Add to dashboard Cite

The positive surgical margins in solid tumors has been a disturbing issue for clinicians. Chemotherapy is an important method to deal with the positive margin. However, systemic chemotherapy is required for long-term administration and has great side effects on health, which cause great pain to the patients. Local administration of slow-release materials provides an opportunity to improve the situation. In this study, we utilized electrospinning technology to create the drug sustained-release materials with nanofibrous structure, which were made from polylactic acid and a certain proportion of chemotherapy drugs (gemcitabine and cisplatin). In vitro release behavior of the drug sustained-release materials were explored by the high-performance liquid chromatography. The antitumor efficacy of the drug sustained-release materials was preliminarily verified in prostate cancer and breast cancer in vitro. Through animal models of breast cancer, the drug sustained-release materials in the treatment of the positive margin has been well documented in vivo, and we also found that the drug sustained-release materials could definitely reduce the liver damage and myelosuppression compared with systemic chemotherapy. In summary, the experimental results showed that the local administration of the drug sustained-release materials could effectively inhibit the growth of the positive incision margins and definitely reduce the partial side effects associated with systemic chemotherapy.

show abstract

Positive Nipple Margin After Nipple-Sparing Mastectomy: An Alternative and Oncologically Safe Approach to Preserving the Nipple–Areolar Complex

Abstract: Management of positive nipple margin after NSM with subareolar shave biopsy is a safe alternative to preserve the NAC.

Cited by 16 publications

References 12 publications

Immediate Nipple Reconstruction With Areolar Flaps After Nipple Excision

Immediate Nipple Reconstruction With Areolar Flaps After Nipple Excision

Oncologic Outcomes of Nipple-Sparing Mastectomy with Immediate Breast Reconstruction in Patients with Tumor-Nipple Distance Less than 2.0 cm

The Delivery Materials with Chemotherapy Drugs for Treatment of the Positive Margin in Solid Tumors

Contact Info

Product

Resources

About