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Plastic and Reconstructive Surgery Sep 2023Women of reproductive age are chronically underrepresented in breast cancer studies. Recent studies suggest that almost 40% of patients diagnosed with breast cancer who...
BACKGROUND
Women of reproductive age are chronically underrepresented in breast cancer studies. Recent studies suggest that almost 40% of patients diagnosed with breast cancer who are of reproductive age want to have children after completing treatment. In this study, the authors evaluated patients of reproductive age who had undergone nipple-sparing mastectomy (NSM) and implant-based reconstruction. The authors compared those who became pregnant with those who did not with respect to clinical and radiologic changes that are reported at follow-up.
METHODS
Any patient 45 years of age or younger at the time of NSM was determined to be of reproductive age, selected for evaluation, and followed prospectively. The presence or absence of breast examination changes in the setting of pregnancy after NSM was recorded.
RESULTS
A total of 36 patients became pregnant after NSM, and 158 patients did not become pregnant after NSM. Of those who became pregnant, nearly half reported some clinical change just before or immediately after delivery. These changes included color change and discharge at the residual nipple-areola complex and palpable nodularity elsewhere. For those with palpable changes, an ultrasound was performed and hypoechoic lesions with variable vascularity were identified. For those who went on to excision, lactational hyperplasia was the most common diagnosis.
CONCLUSIONS
Ultrasound is an appropriate first-line investigation of breast changes, which can include hyperplasia of remaining ductal and glandular tissue. Patients who became pregnant after NSM commonly had clinical breast examination changes, but the majority of these changes were found to be benign on further evaluation.
CLINICAL QUESTION/LEVEL OF EVIDENCE
Risk, II.
Topics: Pregnancy; Child; Female; Humans; Breast Neoplasms; Mastectomy; Nipples; Hyperplasia; Mastectomy, Subcutaneous; Mammaplasty; Retrospective Studies
PubMed: 36727812
DOI: 10.1097/PRS.0000000000010199 -
Annals of Surgical Oncology Oct 2015The nipple and areola are pigmented areas of modified skin that connect with the underlying gland of the breast via ducts. The fairly common congenital anomalies of the... (Review)
Review
The nipple and areola are pigmented areas of modified skin that connect with the underlying gland of the breast via ducts. The fairly common congenital anomalies of the nipple include inversion, clefts, and supernumerary nipples. The anatomy of the nipple areolar complex is discussed as a foundation to review anatomical variants, and the physiologic development of the nipple, including changes in puberty and pregnancy, as well as the basis of normal physiologic discharge, are addressed. Skin conditions affecting the nipple include eczema, which, while similar to eczema occurring elsewhere on the body, poses unique aspects in terms of diagnosis and treatment. This article concludes with discussion on the benign abnormalities that develop within the nipple, including intraductal papilloma and nipple adenoma.
Topics: Breast Neoplasms; Female; Humans; Models, Anatomic; Nipples; Pregnancy; Skin Diseases
PubMed: 26242366
DOI: 10.1245/s10434-015-4760-4 -
International Journal of Environmental... Dec 2022A number of studies have reported breasts have high fluctuating asymmetry (FA:|Right-Left|), suggesting that they contain evolutionary and clinical information (e.g.,...
BACKGROUND
A number of studies have reported breasts have high fluctuating asymmetry (FA:|Right-Left|), suggesting that they contain evolutionary and clinical information (e.g., high FA correlates with breast cancer risk). Here we focus on breast FA in women with a wide range of breast sizes, including participants with macromastia and/or gigantomastia.
MATERIAL AND METHODS
The sample included 65 women (mean age 33.97 ± 12.1 years). Thirty were randomly selected students and/or patients who regarded their breast size as small, normal or average and who had not undergone or intended to have any breast surgery. The remainder ( = 35) were qualified for breast reduction due to macromastia and/or gigantomastia. In all participants we measured/calculated weight, height and BMI, as well as took chest photographs. Breast volumes and nipple areola complex FAs were evaluated in a specifically-designed software.
RESULTS
Breast size significantly positively correlated with breast volume FA in all women (t = 5.17, < 0.0001) and in women with macromastia/gigantomastia (t = 2.32, = 0.027). All nipple location FAs correlated positively with breast size.
CONCLUSIONS
In women with different breast sizes, breast size correlates with FA calculated from breast volume and nipple location FAs. In women with macromastia and/or gigantomastia, breasts present higher FA than "normal" breasts. This observation may give a rationale for earlier and more frequent prophylactic breast imaging in women with macromastia and/or gigantomastia.
Topics: Female; Humans; Young Adult; Adult; Middle Aged; Hypertrophy; Nipples; Mammaplasty; Mastectomy
PubMed: 36554776
DOI: 10.3390/ijerph192416895 -
European Journal of Surgical Oncology :... Apr 2016Many techniques for nipple-areola complex (NAC) reconstruction are described. Clarity is required on the currently available options. Since a complete list of all the... (Review)
Review
Many techniques for nipple-areola complex (NAC) reconstruction are described. Clarity is required on the currently available options. Since a complete list of all the techniques described until now is not available, a possibly comprehensive literature overview was carried out from 75 papers (years 1946-2015). The local flap was the most frequently described technique for the nipple reconstruction with no significant difference in complications' rate among the various types of techniques. Complications in nipple reconstruction were 46.9% after graft, 7.9% after local flap, and 5.3% in case of flaps with autologous graft/alloplastic/allograft augmentation, while complications in areola reconstruction were 10.1% after graft, and 1.6% after areola tattoo. Flaps appear to be more reliable than grafts in nipple reconstruction, while tattoo is thought to be safer than graft in areola reconstruction. The loss of projection, although considerable (45%-75%), had not significant impact on patients' satisfaction. Due to contraction, overcorrection of 25-50% of the desired result is advisory when adopting local flaps, in order to prevent loss of projection. The use of flaps with autologous graft/alloplastic/allograft augmentation (cartilage, fat, calcium hydroxylapatite, acellular dermal matrix, polymethylmethacrylate, biologic collagen) showed a minor loss of nipple projection but may expose to a relative increased number of postoperative flap necrosis.
Topics: Acellular Dermis; Female; Humans; Mammaplasty; Nipples; Patient Satisfaction; Skin Transplantation; Surgical Flaps
PubMed: 26868167
DOI: 10.1016/j.ejso.2016.01.003 -
Radiographics : a Review Publication of... 2022Nipple-sparing mastectomy (NSM) is increasingly offered to patients undergoing treatment of breast cancer and prophylaxis treatment for reduction of breast cancer risk....
Nipple-sparing mastectomy (NSM) is increasingly offered to patients undergoing treatment of breast cancer and prophylaxis treatment for reduction of breast cancer risk. NSM is considered oncologically safe for appropriately selected patients and is associated with improved cosmetic outcomes and quality of life. Accepted indications for NSM have expanded in recent years, and currently only inflammatory breast cancer or malignancy involving the nipple is considered an absolute contraindication. Neoplasms close to and involving the nipple areolar complex are common, and cancer of the lactiferous ducts can spread to the nipple. Therefore, accurate determination of nipple involvement at imaging examinations is critical to identifying appropriate candidates for NSM and preventing local recurrence. Multiple imaging features have been described as predictors of nipple involvement, with tumor to nipple distance, enhancement between the index malignancy and the nipple, and nipple retraction demonstrating the highest predictive values. These features can be assessed at multimodality breast imaging, particularly at breast MRI, which demonstrates high specificity and negative predictive value for determining nipple involvement in malignancy. RSNA, 2022.
Topics: Breast Neoplasms; Female; Humans; Mammaplasty; Mastectomy; Nipples; Quality of Life; Radiologists; Retrospective Studies
PubMed: 35179983
DOI: 10.1148/rg.210136 -
Clinics in Plastic Surgery Apr 2016Assessing risk and avoiding complications in breast reduction requires a meticulous history, systematic physical examination, management of expectations, and careful... (Review)
Review
Assessing risk and avoiding complications in breast reduction requires a meticulous history, systematic physical examination, management of expectations, and careful consideration and execution of operative technique. Attention should be paid to comorbidities. Shape, symmetry, contours, scar location, skin quality, nipple-areolar complex (NAC) shape, NAC position relative to inframammary fold, and NAC position relative to the volume of the breast should be evaluated. Because complications cannot always be anticipated, informed consent is a vital part of managing expectations. Intraoperative considerations include blood pressure control, limiting tension, delayed healing and tissue loss, and using applied anatomy to avoid malposition and asymmetry.
Topics: Cicatrix; Female; Humans; Mammaplasty; Nipples; Postoperative Complications; Risk Assessment; Wound Healing
PubMed: 27012790
DOI: 10.1016/j.cps.2015.12.007 -
Annals of Plastic Surgery Oct 2022Crescent mastopexy is an operation that is often maligned and infrequently used. However, it can be a useful adjunct both in primary augmentation mammaplasty and in...
Crescent mastopexy is an operation that is often maligned and infrequently used. However, it can be a useful adjunct both in primary augmentation mammaplasty and in secondary breast revision cases. The key to achieving good results with this procedure lies in conceptualizing the operation in 3 dimensions rather than 2. Most publications about the surgical technique describe deepithelialization (or at most full-thickness skin resection) of a crescent-shaped area superior to the areola and a single-layer closure of the defect. Improved outcomes are achieved if a full-thickness composite segment of tissue-skin, subcutaneous fat, and a wedge of breast parenchyma-is resected and the resulting defect closed in multiple layers. A more fitting descriptive term for this procedure, one that conveys the 3-dimensional nature of the tissue resection, is "croissant mastopexy." Croissant mastopexy has been used by the author in primary augmentation in women with mild to moderate ptosis, in patients with asymmetrical nipple position and in patients with tuberous breast deformity. The procedure is also applicable in secondary cases, but precautions must be taken to ensure that blood supply to the nipple is not compromised. When properly executed, croissant mastopexy yields good results without undue stretching of the superior half of the areola and with acceptable scars.
Topics: Breast Neoplasms; Female; Humans; Mammaplasty; Nipples; Retrospective Studies
PubMed: 35703195
DOI: 10.1097/SAP.0000000000003210 -
Annals of Surgical Oncology Nov 2015
Topics: Breast Neoplasms; Female; Humans; Mastectomy, Segmental; Neoplasm Recurrence, Local; Nipples; Patient Selection
PubMed: 26036186
DOI: 10.1245/s10434-015-4648-3 -
Aesthetic Plastic Surgery Oct 2021Mastopexy in combination with implant breast augmentation still remains a controversial topic in plastic surgery because of its complexity and its relative high rate of... (Observational Study)
Observational Study
INTRODUCTION
Mastopexy in combination with implant breast augmentation still remains a controversial topic in plastic surgery because of its complexity and its relative high rate of complications. To obviate the need of a breast implant, numerous authors described glandular rearrangement techniques to optimize upper pole fullness and breast projection. More recently, the combination of mastopexy and lipofilling has been described. The aim of this study is to report our experience on one-stage mastopexy-lipofilling in cosmetic breast surgery, describing our surgical technique and focusing on long-term esthetic results and patient-reported outcomes.
MATERIAL AND METHOD
A prospective observational study was performed including all patients underwent cosmetic one-stage mastopexy-lipofilling. Collected data included patient's age and BMI, smoking, preoperative and postoperative cup size and grade of ptosis, preoperative and postoperative distances between the upper part of the nipple areola complex and the inframammary fold and between the upper part of the nipple areola complex and the sternal notch, mean liposuction and fat injection volume, mean operating time and postoperative complications. Cosmetic results and patient satisfaction were evaluated using the 5 points Likert scale considering breast volume, shape, symmetry, quality of scars, nipple areola complex and donor site shape and global satisfaction.
RESULTS
A total of 21 patients (42 breasts) were included with a mean follow-up of 13.8 months. Mean liposuction and injection volumes were 1070 mL and 230 mL, respectively. With respect to breast size, 11 patients (52.4%) showed an increase in one-cup size, while 10 patients (47.6%) showed a slight increase in volume without changing cup size. The mean NAC-SN and NAC-IMF distances decreased by an average of 3.7 cm and 1.7 cm, respectively. Regarding esthetic outcomes, the mean scores for breast volume, shape, symmetry, quality of scars, nipple areola complex and donor site shape were 4.1, 4.2, 4.9, 4, 4.6 and 5, respectively. With respect to patient satisfaction, mean scores for breast volume, shape, symmetry, quality of scars, nipple areola complex and donor site shape were 4.2, 5, 5, 4.7, 5 and 5, respectively. The achievement of a satisfactory outcome (> 4) was obtained in all patients but 1 with a mean score of 4.5 (3-5).
CONCLUSION
The current study suggests that one-stage mastopexy-lipofilling is a safe technique, which leads with satisfactory outcomes allowing breast contouring and breast volume increase.
LEVEL OF EVIDENCE IV
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Topics: Breast Neoplasms; Esthetics; Female; Humans; Mammaplasty; Nipples; Prospective Studies; Retrospective Studies; Surgery, Plastic; Surgical Flaps; Treatment Outcome
PubMed: 33982157
DOI: 10.1007/s00266-021-02327-y -
Revista Brasileira de Enfermagem 2021to construct and validate a classification of nipple and areola complex lesions resulting from breastfeeding, according to content and appearance.
OBJECTIVES
to construct and validate a classification of nipple and areola complex lesions resulting from breastfeeding, according to content and appearance.
METHODS
this is a methodological study, developed in four stages: operational definition, instrument construction, content and appearance validation. The Delphi technique and a Likert-type scale were used to validate content and appearance, through the participation of ten and sixteen judges, respectively. For analysis, Content Validity Index and Kappa Coefficient were applied.
RESULTS
Content Validity Index obtained an overall value of 0.93 and, for appearance, 0.94. Kappa values ranged between 0.46 and 1. The high rates of agreement among judges demonstrated the quality of the proposed content validity.
CONCLUSIONS
the Nipple and Areola Complex Lesions Classification Instrument developed obtained acceptable values of its indexes, proving to be valid in terms of content and appearance.
Topics: Nipples; Research Design
PubMed: 34614083
DOI: 10.1590/0034-7167-2021-0051