Expanding the Use of Nipple-Sparing Mastectomies in Obese Patients Undergoing Staged Implant-Based Reconstruction

Background: Advantages of various mastectomy techniques include skin reduction and favorable aesthetics in Wise-pattern closures, and less visible scars in nipple-sparing mastectomies (NSM). This study compares postoperative complication profiles between Wise-pattern and nipple-sparing mastectomies in the obese population. Methods: A retrospective chart review of obese patients (BMI ≥ 30) who underwent staged breast reconstruction following Wise-pattern and nipple-sparing mastectomies at our institution between February 2016 and January 2020 was conducted. Complications between cohorts were analyzed using the independent samples t-test (2-sided) and the χ2 test. Results: A total of 232 breasts (163 Wise-pattern, 69 NSM) were re-constructed in 123 obese female patients (85 Wise-pattern, 38 NSM). Complication rates in both the Wise-pattern and NSM patient cohorts were similar following stage 1 (Wise-pattern: 30.7%, NSM: 39.1%, p = 0.212) and stage 2 (Wise-pattern: 16.6%, NSM: 15.9%, p = 0.907) of reconstruction. No statistically significant differences in rates of infection, dehiscence, seroma, hematoma or malposition of tissue expander (TE)/implant following stage 1 or stage 2 were found between cohorts. Conclusions: There were no significant differences in postoperative complication rates between the Wise-pattern and NSM cohorts of obese patients. NSM can be a viable surgical option in carefully selected obese patients and offer the advantage of concealed scarring.

Evaluation of the Efficacy of 99.9% Pure Silver Trilaminate Cups in the Prevention and Treatment of Nipple Pain and Fissures

Breastfeeding is drastically decreasing over time and nipple trauma constitutes one of the most significant reasons for its discontinuation. In this context, this study aimed at evaluating the effectiveness and tolerability of a topical treatment device, namely Silver Cap® (Depofarma S.P.A.), when used to prevent pain and nipple fissure formation. The medical device consists in a silver trilaminate cup to be placed on the nipple, providing physical protection and creating a moist environment. The study involved 187 women: 38 started to apply the device prior to lactation (PL group) and 149 during lactation (DL group). Aiming to collect safety and performance data, both groups were provided with questionnaires during 6 consecutive visits (120 days of follow-up). At last visit, absence of painful symptoms was reported by the 98.8% and the 100% of women in DL and PL groups, respectively. Moreover, no nipple fissures were observed and no adverse events directly correlated to use of the device were reported. According to these findings, it can be concluded that Silver Cap® is a safe and effective device for nipple pain and fissure prevention. .

The Long Term Follow-Up Results of the Direct Nipple Ureteroneocystostomy Technique: A Prospective Study

Objective: To evaluate the long term follow-up results of the direct nipple ureteroneocystostomy technique. Materials and Methods: We studied a total of 16 patients (19 renal units) who underwent direct nipple ureteroneocystostomy. The mean age was 43 years and 3 patients had bilateral disease. In five units the ureters had been ligated during gynecological surgery, 11 renal units were obstructive and three units were reflexive megaureters. The ureters were spatulated for about 2 cm and folded back. Nipples 2 to 2.5 cm long were prepared. In two cases the ureters were thin-walled (2 mm or less) and they were not spatulated but folded back onto themselves. In one case the ureter could not be everted since it had a thick and fibrotic wall. The distal 2 to 2.5 cm segment of this ureter was directly inserted in to the bladder. Postoperative follow-up was at 3 month intervals for the first year at 6 month intervals for 2 - 3 years and yearly thereafter. At the time of follow-up serum creatinine, urine culture, ultrasound, intravenous urography, voiding cystoureterography, nuclear renal scintigraphy and cystometric evaluations were performed. The functions of 11 and 15 renal units were evaluated scintigraphically and stereologically, respectively, in the both preoperative and postoperative first year follow-up. The Wilcoxon Signed Ranks test was used for statistical evaluation and p < 0.05 was considered statistically significant. Results: Mean follow-up was 49 months. Three renal units had Grade III reflux (two of them during voiding) and one unit had Grade IV reflux. At follow-up this patient developed in the ureteral stricture. No patients had urinary tract infection, pyelonephritis or ureteral stricture follow-up period. Between the preoperative and postoperative first year, there was an increase in postoperative split renal function based on renal scintigraphy but this difference was not statistically significant. The stereologically calculated decrease in pelvicaliceal dilatation was statistically significant. Conclusion: Ease of application and no need to taper or plicate the ureter or prepare a submucosal tunnel may be the reasons to consider the direct nipple ureteroneocystostomy technique for megaureters of different etiologies.

Immediate Nipple Reconstruct!on Following Breast Reduction

Necrosis of nipple-areola complex is one of the major complications of breast reduction in gigatomastia.Wie present a case study of a 32-year-old patient with severe gigantomastia,who required an immediate nipple reconstruction during breast reduction.The final reconstruction was satisfactory.No complications were observed within three months postoperatively.

Expander implantation for correction of high-riding nipple with enlarged nipple-areola complex using revision mastopexy: A case report

BACKGROUND High-riding nipple is one of the common complications after mastopexty and breast reconstruction.However,to date,a limited number of techniques have concentrated on how to lower the high-riding nipple with enlarged areola.CASE SUMMARY This is a case report describing a combination of surgical techniques to decrease high-riding nipple.A 26-year-old woman,who previously underwent several breast operations,sought correction for high-riding nipple with enlarged areola.Expanders were used and multi-stage techniques were performed.After one year of follow-up,lowered nipple,reduced areola size,ensured nipple blood supply,and improved breast ptosis were achieved,and the patient was satisfied with the breast contour.CONCLUSION The proposed technique offers a feasible treatment option for postoperative nipple over-elevation combined with areola dilation.

Value of Fiberoptic Ductoscopy in Diagnosing and Treating Multiporous Nipple Discharge

OBJECTIVE To explore the value of fiberoptic ductoscopy in diagnosing and treating bilateral and polyporous nipple discharge (ND).METHODS Fiberoptic ductoscopy was conducted in 29 patients with bilateral and polyporous ND.After the ductoscopy,the patients with intraductal papilloma (IDP) underwent a surgical procedure,and the others,identified with galactostasis,mammary duct ectasia (MDE) and obstructive galactophoritis (OG),received a ductoscopy-guided interventional therapy. RESULTS Among 29 cases,and with 79 galactophores examined,IDP was found in 11 cases (37.9% of the total cases),or 13.9% of the galactopores examined.IDP was found in 9 of 11 cases with a bloody nipple discharge,while IDP was seen in 2 of the 18 cases with a non-bloody nipple discharge.The excision accuracy achieved 100% in the cases,and postoperative pathological diagnosis accordance rate reached 88.9%. CONCLUSION Fiberoptic ductoscopy has many features such as ability to see the lesion,and accurate preoperative localization,thus eliminating excessive excision of tissue during surgery.For most patients with ND,especially those suffering galactostasis,OG or MDE,washout under fiberoptic ductoscopy and interventional therapy may achieve a thorough cure of the disease.

Immediate nipple-areola-sparing mastectomy reconstruction: An update on oncological and reconstruction techniques

Nipple-sparing mastectomy(NSM) is a safe technique in patients who are candidates for conservation breast surgery. However, there is worry concerning its oncological safety and surgical outcome in terms of postoperative complications. The authors reviewed the literature to evaluate the oncological safety, patient selection, surgical techniques, and also to identify the factors influencing postoperative outcome and complication rates. Patient selection and safety related to NSM are based on oncological and anatomical parameters. Among the main criteria, the oncological aspects include the clinical stage of breast cancer, tumor characteristics and location including small, peripherally located tumors, without multicentricity, or for prophylactic mastectomy. Surgical success depends on coordinated planning with the oncological surgeon andcareful preoperative and intraoperative management. In general, the NSM reconstruction is related to autologous and alloplastic techniques and sometimes include contra-lateral breast surgery. Choice of reconstructive technique following NSM requires accurate consideration of various patient related factors, including: breast volume, degree of ptosis, areola size, clinical factors, and surgeon's experience. In addition, tumor related factors include dimension, location and proximity to the nipple-areola complex. Regardless of the fact that there is no unanimity concerning the appropriate technique, the criteria are determined by the surgeon's experience and the anatomical aspects of the breast. The positive aspects of the technique utilized should include low interference with the oncological treatment, reproducibility, and long-term results. Selected patients can have safe outcomes and therefore this may be a feasible option for early breast cancer management. However, available data demonstrates that NSM can be safely performed for breast cancer treatment in selected cases. Additional studies and longer follow-up are necessary to define consistent selection criteria for NSM.

Adenoma of the Nipple, Mimicking Paget’s Disease of the Breast: Report of a Case

Nipple adenoma is a rare benign condition that simulates malignancy. A 37-year-old woman presented with unilateral bloody nipple discharge for 1-year duration followed by severe nipple erosion. As biopsy revealed nipple adenoma and therefore, complete local excision was done. The final histopathology showed florid papillomatosis which was adequately excised. Nipple adenoma although rare entity this should be included in the differential diagnosis of any nipple erosion such as carcinoma and Paget’s disease of the breast specially when associated with bloody discharge in premenopausal women.

A Study on Control System of Robot Working Unit for Automatically Welding Nipples onto Header of Boiler

The difficult problem of automatically welding nipples onto the header is first analyzed in this paper, and then the overall structure and operating principle of the robot working unit are introduced. The robot and the measuring device are located by employing the traveling lorry, and this unit enables the robot to adjust the tracks according to the errors received from the measuring device, and then the nipples are welded properly. This paper emphases on the development of the master-slave control system, in which the prograrmmable Logic Controller (PLC) is used as the master computer.

Nipple-Areola Sparing Mastectomy Followed by Immediate Breast Reconstruction in 126 Patients

This study is to explore the indications, procedures, effectiveness, and feasibility of nipple-areola sparing mastectomy followed by immediate breast reconstruction. The nipple-areola sparing mastectomy followed by immediate breast reconstruction was performed in 126 patients with breast cancer from June 2005 to October 2011. The cosmetic outcomes of the reconstructed breasts were evaluated according to objective and subjective criteria. Meanwhile, the postoperative complications were observed and the therapeutic efficacies were followed up. All the operations were successful. Six patients experienced mild complications early after surgery and were resolved after symptomatic treatment. Both the subjective and objective evaluation for the aesthetic outcomes yielded a satisfactory rate of 97.62% during the 6-80-month follow-up. No recurrence or metastasis was found in 118 cases. Nipple-areola sparing mastectomy followed by immediate breast reconstruction is a simple and effective option for significantly improving the cosmetic outcomes and quality of life of patients, without serious complications or impact on the comprehensive treatment and long-term effect against breast cancer.

Aesthetic Outcome after Nipple Sparing Mastectomy for Cancer Patient Egyptian Pattern

Background: Recent advances in breast reconstruction and the introduction of oncoplastic techniques have resulted in significant improvement in quality of life and psychological well-being of most patients. Nipple sparing mastectomy is a surgical technique that removes breast tissue while preserving the native skin envelope, infra-mammary fold and the NAC, which allows immediately reconstructed breasts to have an excellent cosmetic outcome. Aim: Our primary end point was for objective assessment of aesthetic outcome after NSM via more accurate new method and subsiding bias in that assessment and the secondary end point was for evaluating the influence of incision choice and recommending which incision is the best for each patient putting in mind cup size, degree of ptosis and body mass index of Egyptian patients. Methods: Starting January 2013 to November 2015, 74 patients with breast cancer underwent NSM with immediate reconstruction using LD flap with or without implant augmentation. Results: Incisions used are elliptical (37.8%), lateral (27%), peri-areolar (21.6%) and infra-mammary (13.5%). In 81.1% of the patients, the procedure was performed using extended LD flaps only, while in the remaining 18.9% the flaps were augmented using implant insertion. Axillary dissection was done in 68.9% of patients and SLN in 24.3% of patients. Overall aesthetic results were done by patient self-assessment, assessment by the surgeon, assessment by professional plastic breast surgeon and assessment by onco-plastic surgeon, and this was followed by statistical analysis of the agreement between the plastic surgeon and the onco-plastic surgeon. Conclusion: NSM is safe, feasible and offers adequate oncologic results along with excellent cosmetic outcome. Choice of incision and reconstruction should be tailored to suit each patient. Breast cancer patients can benefit from sound resection and enjoy a sense of wholeness.

Usefulness of Free Nipple-Areola Complex Graft for Nipple Malposition after Nipple Sparing Mastectomy

Purpose: This article identifies the advantage and disadvantage of a free nipple areola complex graft (FNACG) for nipple malposition which resulted from tissue-expander insertion and subsequently replaced with an implant after nipple sparing mastectomy (NSM). Methods: The subjects were three such patients treated using FNACG and who were followed up for at least one year postoperatively. The surgical outcome was assessed for symmetry of nipple-areola position, graft take, depigmentation, and shrinkage. Results: In all patients, the graft was accurately transferred to a position to achieve symmetry with the unaffected breast, and there was complete graft take in the areola by simple surgical design and techniques. No depigmentation of the areola was observed. The size of the areola was almost unchanged after grafting in two patients, but areolar shrinkage occurred in one other patient. There was complete graft take in the nipple in one patient and no depigmentation of the nipple was observed. Necrosis occurred at the tip of the nipple in two other patients. These patients had depigmentation, and the height of nipples decreased in proportion to the level of necrosis. Conclusion: FNACG can be a useful method if its advantages and disadvantages are well considered.

Extramammary Paget’s Disease Covered the Left Nipple and Areola

We present a case of a 71-year-old woman suffering from mammary Paget,s disease and having a 10-years history of an irregular, widespread erosion accompanied by itching and burning on the skin of her left chest, extending to the breast. The erosion had steadily enlarged and had become increasingly tender. The nipple and areola of the left breast disappeared and could not be recognized. No abnormality of the right nipple, areola, and covering skin and no supernumerary nipple were seen. Mammography and ultrasonography could not be performed because of severe pain and erosive wetness. Histopathology of a surgical biopsy specimen showed epidermal infiltration by large, round, clear atypical cells scattered individually or in small clusters and distributed horizontally throughout the epidermis. The cytoplasm of these large cells was pale and vacuolated and was equivalent to that in nipple cells in Paget,s disease, and a diagnosis of mammary Paget,s disease was made. We performed total mastectomy of the left breast with wide excision of the Paget lesion of the left chest and axillary lymph node sampling. Histological examination of the specimen showed typical distribution of Paget,s cells;however no ductal carcinoma in situ was found in the mammary ducts and invasive growth was not recognized beyond the basal membrane of the lesion. From this evidences, we established a diagnosis of large, irregulaly shaped unusual mammary Paget,s disease, not of breast cancer origin, covering the left breast, areola, and nipple.

The Effect of the Moufarrege Total Posterior Pedicle Reduction Mammaplasty on the Erogenous Sensation of the Nipple

Traditional reduction mammoplasties have the simple concern to guarantee the survival of the nipple areola complex after surgery. Little has been done to take care of essential functions in the nipple, especially the erogenous sensation. We have conducted a retrospective study on a cohort of 573 female patients operated using the Total Posterior Pedicle of Moufarrege between 1985 and 1995 to evaluate its effect on the erogenous sensation of the nipple. This study demonstrated the preservation of the erogenous sensation of the nipple in a high proportion of these patients. The physiology of this preservation is explained in regard of the technique details in Moufarrege mammoplasty compared to other techniques. The Moufarrege Total Posterior Pedicle would therefore be a highly reliable reduction technique to ensure the preservation of the erogenous sensation of the nipple.

Trillium Flap for Postmastectomy Neo-Nipple Reconstruction (A Novel Technique)

Introduction: Breast cancer cases, mastectomy and following reconstruction procedures are growing in numbers. Despite being lifesaving, mastectomies have a destructive psychological impact on the patients. On the other hand, breast reconstruction improves psychological damages within the same population. Various techniques for nipple reconstruction were described in literature. Trillium flap is an innovative technique to reconstruct neo-nipple with several advantages that make it superior to other popular flaps. Objectives: To come up with an innovative design for reconstructing a neo-nipple post mastectomy, that is superior to other popular flaps. Results: The Trillium flap design has less visible and easily camouflaged scars, is geometry-based, specific, well-detailed and flexible to produce a tailored nipple with any desired height and diameter and ensures the flaps good vascularity and the neo-nipple projection sustainability. Conclusion: Trillium flap is an innovative technique to reconstruct neo-nipple with several advantages that make it superior to other popular flaps. The results shown in the study are for experimental procedures done on human tissue samples of excised flaps from abdominoplasties and brachioplasties. Further application on actual cases is needed with monitoring of neo-nipple projection sustainability on the long term.

Complication after nipple-areolar complex tattooing performed by a non-medical person:A case report

BACKGROUND Compared to earlier,there has been an increase in the tattoo procedures for cosmetic purposes;and there has also been an increase in the tattoo procedures performed by non-medical personnel.In South Korea,only tattoos performed by a doctor are considered legal;however,there is still some debate over whether tattoo procedures performed by non-healthcare providers should be considered legal.CASE SUMMARY A 28-year-old woman visited our hospital with pain in both nipples and heat sensation over the last 4 d.She had a history of a nipple tattoo performed by an unlicensed person.Pinpoint bleeding was noted in both areolar areas,and the exudate mixed with pus and orange color ink was discharged.Oral medication and tulle with foam dressing were performed under the impression of cellulitis and allergic reaction.After 4 wk,nipples remained dark brown in color,resulting in a color mismatch between the nipple and orange-colored areola.The size of the areola was also found to be distinctly asymmetrical after healing.This complication may have been caused by the use of illegal ink or unsanitary procedures,or a problem may have occurred in the post-tattoo management stage.CONCLUSION Doctors use approved ink,aseptic procedure and appropriate postoperative care,and appropriate management can be performed in case of complications.

Application of mastoscopic in modified radical operation for preserving nipple-areolar complex

Objective: To probe the effect of mastoscopic in modified radical mastectomy operation for preserving nipple-areolar complex in the treatment of breast cancer. Methods: Thirty patients, with breast cancer of a diameter≤3 cm and a distance≥3 cm from the mammary areola were treated by mastoscopic from November 2003 to August 2006. After the lipoly- sis and suction of axillary fat, mastoscopic axillary lymph node dissection was performed. Results: The average operation time was 128.9 min (120–156 min), the intraoperative blood loss was 56 mL (30–100 mL). The mean lymph nodes harvested by endoscopy were 16 (6–34). Excellent cosmetic outcomes were obtained with symmetrical breast development and all the patients were satisfied with the treatment. Postoperative follow-up for 2–29 months (mean, 16.6 months) found no local recur-rence. Conclusion:This model of operation can protect the upper limb function and has value of aesthetics of the brisket. What’s more, improve the quality of survive of the patients.

The Place of Nipple-Sparing Mastectomy in the Treatment of Breast Cancer: Review of the Literature

Introduction: Mastectomy with conservation of the nipple-areola complex (NAC) in breast cancer care has been controversial with regards to the oncological safety of this procedure and the risk of complications including NAC necrosis. Aim: The objective of this study is to assess, through a literature review, the safety and reliability of a conservative NAC mastectomy in breast cancer treatment, paying attention to the rate of local recurrence and complications. Methods: A review of the literature was conducted from PubMed data, and articles published between January 2007 and December 2017, using the terms “nipple-sparing mastectomy”, “breast cancer”, “local recurrence”, “necrosis of the nipple”, “global complications”. The articles were analyzed with regards to the following parameters of evaluation: local recurrence, recurrence rate at NAC level, global complication rates and nipple necrosis rates. Results: In the 36 studies we selected, the average rate of local recurrence was 3.23%. The average rate of recurrence at the NAC was 0.81%. The average rate of complications was 20%. The average rate of necrosis of the NAC was 5.9%. The main factors of these recurrences were the tumor size > 5 cm and tumor stage > stage II. Conclusion: Conservative mastectomy of the nipple-areola complex offers an aesthetic advantage and oncological safety in carefully selected patients with breast cancer.

Upper Footprint Dependent Nipple Position to Avoid High-Riding Nipple after Reduction Mammoplasty

Introduction: High-riding nipple following reduction mammoplasty is a challenging problem for the plastic surgeons. To avoid such problem, many methods have been described for marking the correct nipple position but still controversial. We aimed in this study to present our experience in preventing excessive nipple elevation after reduction mammoplasty by using the upper footprint to set the new nipple position. Material and Methods: From March 2019 to March 2022, 25 female patients at a mean age of 38.3 years were included in this prospective study. They underwent reduction mammoplasty with inverted T scar and a combination of inferior pedicle and Würinger’s septum techniques. Resection weights, pre- and postoperative anthropometric measures were recorded. All patients were photographed at the follow-up visits and evaluated for complications if any, the nipple-areola complex (NAC) sensation, and subjective patient satisfaction using “The Breast Evaluation Questionnaire”. Results: The mean preoperative midclavicular point to nipple distance was 37.40 and 37.18 cm for the right and left breasts, respectively. The mean resection weight was 1270 and 1242 g from the right and left sides, respectively. None of our patients experienced NAC necrosis, while 2 breasts had minor wound dehiscence treated conservatively. After a mean follow-up period of 12 months, the NAC descended by an average of 1.40 cm, the distance from the IMF to nipple had an average increase of 2.24 cm, and all of patients were satisfied with the esthetic outcomes and convinced with their breast shape. Conclusion: The upper footprint dependent nipple position seems to have a real role in preventing high-riding nipple after breast reduction in hypertrophic and gigantomastic breasts. Moreover, it can be applied easily and allow for more satisfying outcomes than other methods for setting the new nipple position.

Prediction of Nipple and Areola Complex Invasion in Breast Cancer Patients. Clinical and Pathological Study of Surgical Specimens

Breast conservation surgery (BCS) and nipple-areola-sparing (NAS) mastectomy have been recognized as two milestones in this period. This study included 60 Egyptian female patients with breast cancer, all of them were subjected to modified radical mastectomy operation. Methods: This study included female patients > 18 years old who have breast cancer with healthy looking non invaded skin of nipple and areola and excluded patients < 18 years old, patients unfit for surger, patients previously subjected to chemo or radiotherapy for breast cancer. We peformed clinical examination of 60 patients with breast cancer. We studied the relevant factors that affect NAC invasion such as patient’s age, menstrual state, family history, tumor size, tumor location (central vs peripheral), tumor to nipple distance, lymphovascular invasion of NAC, lymph node metastasis, histological tumor type, tumor stage, multifocal/multicentric tumors and (ER, PR, HER2) status. Result: In our study, we have shown that NAC invasion is strongly associated with: 1) Nipple retraction as a patient’s complaint;2) Tumor site;3) Tumor-nipple-distance ≤ 4 cm;4) Multifocal/multicentric tumor;5) Tumor grade (grade III tumors);6) Positive lymph node invasion;7) ER and PR receptors negativity;8) HER2 positivity. This helps in preoperative planning for selecting patients for NAS mastectomy. Conclusion: The ideal patients for NAS mastectomy are with these criteria: 1) Clinically normal nipple areola complex;2) Distance from the tumor to the nipple is >4 cm;3) No multifocal/multicentric tumor;4) Absence of lymph node invasion;5) Tumor grade (grade I, II);6) Peripheral not central tumor;7) No sub-areolar lymphovascular invasion (LVI);8) ER receptor positive;9) PR receptor positive;10) HER2 negative.