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The Surgeon : Journal of the Royal... Oct 2021There is currently no validated patient-reported outcome measure (PROM) that is specific to nipple-areola complex (NAC) reconstruction. This paper evaluates all... (Review)
Review
BACKGROUND
There is currently no validated patient-reported outcome measure (PROM) that is specific to nipple-areola complex (NAC) reconstruction. This paper evaluates all patient-reported outcomes for NAC reconstruction in the literature.
METHODS
Systematic literature searches of The Cochrane Central Register of Controlled Trials, MEDLINE and World Health Organization International Clinical Trials Registry Platform were conducted to identify all primary studies with patient-reported outcomes for NAC reconstruction. The primary outcome measures were patient satisfaction rates for appearance and symmetry of NAC reconstruction.
RESULTS
Fifty-nine papers were included in this review. Reported patient satisfaction was generally high, with the pooled average satisfaction rate for appearance being 81.9% and symmetry 80.3%. 89.5% of respondents would do it again and 94.8% would recommend it to others. There is no standardised or validated PROM specific to NAC reconstruction and this contributes to a lack of conclusive findings from studies in this area.
CONCLUSION
There is a need for a validated PROM that is specific to NAC reconstruction, in order to serve as a standardised outcome assessment to guide further research and improve patient care.
Topics: Breast Neoplasms; Female; Humans; Mammaplasty; Nipples; Patient Reported Outcome Measures; Patient Satisfaction; Retrospective Studies
PubMed: 33423920
DOI: 10.1016/j.surge.2020.11.005 -
Journal of Plastic, Reconstructive &... Feb 2017Rare but serious complications of nipple-sparing mastectomy (NSM) include necrosis of the nipple-areolar complex (NAC) and mastectomy skin flaps. NAC and mastectomy flap... (Review)
Review
BACKGROUND
Rare but serious complications of nipple-sparing mastectomy (NSM) include necrosis of the nipple-areolar complex (NAC) and mastectomy skin flaps. NAC and mastectomy flap delay procedures are novel techniques designed to avoid these complications and may be combined with retroareolar biopsy as a first-stage procedure. We performed a systematic review of the literature to evaluate various techniques for NAC and mastectomy flap delay.
METHODS
PubMed and Cochrane databases were searched from January 1975 through April 15, 2016. The following search terms were used for both titles and key words: 'nipple sparing mastectomy' AND ('delay' OR 'stage' OR 'staged'). Two independent reviewers determined the study eligibility, only accepting studies involving patients who underwent a delay procedure prior to NSM and studies with objective results including specific outcomes of NAC and mastectomy flap necrosis.
RESULTS
The literature search yielded 242 studies, of which five studies met the inclusion criteria, with a total of 101 patients. Various techniques for NSM delay have been described, all of which involve undermining the nipple and surrounding mastectomy skin to some degree. Partial NAC necrosis was reported in a total of 9 patients (8.9%). Mastectomy flap necrosis was reported in a total of 8 patients (7.9%). Three of five studies reported positive retroareolar biopsy findings in a total of 7 patients (6.9%).
CONCLUSIONS
Delay procedures for NSM have a good safety profile and may be considered in patients at risk for NAC or mastectomy flap necrosis, such as patients with pre-existing breast scars, active smoking, prior radiation, or ptosis. These procedures have the added benefit of allowing a retroareolar biopsy to be sent for permanent sections prior to mastectomy, allowing the surgical team to plan for the removal of the NAC at the time of mastectomy if indicated and eliminating the risk of a false-negative result on frozen section analysis.
Topics: Breast Neoplasms; Female; Humans; Mammaplasty; Mastectomy, Subcutaneous; Nipples; Surgical Flaps
PubMed: 28040452
DOI: 10.1016/j.bjps.2016.11.012 -
Zhongguo Xiu Fu Chong Jian Wai Ke Za... Jul 2019To review the research on distribution of the nerve and blood supply of breast, and the development of breast reduction in recent years. (Review)
Review
OBJECTIVE
To review the research on distribution of the nerve and blood supply of breast, and the development of breast reduction in recent years.
METHODS
The related literatures about the distribution of the nerve and blood supply of breast, the development of breast reduction, and postoperative lactation function in recent years were reviewed extensively. The above aspects were analyzed and summarized in combination with the author's experiences.
RESULTS
With the anatomical study of mammary gland, nipple areola complex nerve distribution and blood supply, breast reduction has been developed rapidly, and a variety of surgical methods have been formed. But each has its own advantages and disadvantages, and its indications are different. Through the application and improvement of the auxiliary examination technique, severe complications such as nipple areola complex necrosis reduce obviously after operation. Through the selection of position of the incision and pedicle, the degree of retaining the pedicle glands, the application of auxiliary liposuction technique, and the improvement of suture technique, the scar of incision reduces, the sensation of nipple areola is preserved more, and a more satisfactory breast shape is obtained. Some of the patients who gave birth after breast reduction have lactation function.
CONCLUSION
There are some shortcomings in various surgical methods at present, individualized surgical methods should be adopted according to the characteristics of the patients. Further research is needed on how to preserve more sensation of nipple areola, obtain a good and lasting breast shape, and preserve lactation function of women after operation.
Topics: Breast; Female; Humans; Mammaplasty; Nipples; Postoperative Period; Sensation; Suture Techniques
PubMed: 31298012
DOI: 10.7507/1002-1892.201902016 -
Journal of Plastic Surgery and Hand... Oct 2017Most women who have their breast reconstructed are offered NAC reconstruction. Nonetheless, it is unclear what scientific evidence there is for the procedure. The aims... (Review)
Review
BACKGROUND
Most women who have their breast reconstructed are offered NAC reconstruction. Nonetheless, it is unclear what scientific evidence there is for the procedure. The aims of the present systematic review were to evaluate the quality of evidence for benefits and risks with NAC reconstruction, and to examine the evidence for different techniques.
METHODS
Relevant databases were searched. Inclusion criteria were controlled studies comprising ≥20 patients and a case series of ≥50 patients. Included articles had to meet criteria defined in a PICO (Patient, Intervention, Comparison, and Outcome). Data extraction and collection were performed according to the QUADAS tool. The level of evidence of the selected articles was assessed according to the Oxford Centre for Evidence-Based Medicine 2009 guidelines, and total evidence for the different research questions was graded according to the GRADE-system.
RESULTS
A total of 362 abstracts were retrieved following the search. Of these 325 did not meet the inclusion criteria and were excluded, leaving 37 studies to be included in the review. Among these, 36 were case series and one a small randomised non-blinded study Conclusions: The existing quality of evidence for risks and benefits of the operation is very low. It is unclear what the complication frequencies are after the reconstruction, and what effect on quality-of-life the operation has. Prospective studies of high quality are needed to evaluate the health effects and risks with NAC reconstruction.
Topics: Breast Neoplasms; Esthetics; Evidence-Based Medicine; Female; Humans; Mammaplasty; Mastectomy; Nipples; Risk Assessment; Treatment Outcome
PubMed: 27885878
DOI: 10.1080/2000656X.2016.1251935 -
Clinics in Plastic Surgery Apr 2016Early and accurate diagnosis and treatment of nipple-areolar complex (NAC) ischemia and necrosis are fundamental to the practice of breast surgery. Knowledge of breast... (Review)
Review
Early and accurate diagnosis and treatment of nipple-areolar complex (NAC) ischemia and necrosis are fundamental to the practice of breast surgery. Knowledge of breast anatomy, risk factors, and proper technique is not sufficient for avoiding this complication in all cases. Management of this situation is dynamic; it depends on the time of detection, and knowledge of different surgical maneuvers for NAC reperfusion. Management of this complication will continue to improve with technologic advances and research.
Topics: Breast Implants; Female; Humans; Ischemia; Mammaplasty; Nipples; Risk Factors
PubMed: 27012799
DOI: 10.1016/j.cps.2015.12.011 -
Revue Medicale de Liege Oct 2022Nipple-areolar complex anomalies may be secondary to many etiologies from simple anatomic variations to malignant processes as Paget disease or invasive breast cancer,...
Nipple-areolar complex anomalies may be secondary to many etiologies from simple anatomic variations to malignant processes as Paget disease or invasive breast cancer, passing through benign locally aggressive processes as erosive adenomatosis of the nipple. Differential diagnosis is not always simple. If clinical exam and standard radiological checkup can't confirm the benignity of the lesion, a biopsy specimen will be obtained to allow an anatomopathological examination. A precise diagnosis can then be made leading to optimal management. This paper describes how to explore nipple-areolar complex anomalies through an uncommon clinical case associating independently an invasive retro-areolar cancer and a dermatological disease of the areola mimicking a Paget disease.
Topics: Adenoma; Breast Neoplasms; Female; Humans; Nipples; Papilloma; Radiography
PubMed: 36226397
DOI: No ID Found -
Journal of the American Academy of... Jun 2019The evaluation and management of dermatologic diseases of the breast and nipple requires an understanding of the unique anatomy of the breast and nipple and an awareness... (Review)
Review
The evaluation and management of dermatologic diseases of the breast and nipple requires an understanding of the unique anatomy of the breast and nipple and an awareness of the significant emotional, cultural, and sexual considerations that may come into play when treating this anatomic area. The first article in this continuing medical education series reviews breast anatomy, congenital breast anomalies, and benign and malignant breast tumors. An emphasis is placed on inflammatory breast cancer and breast cancer with noninflammatory skin involvement and on cutaneous metastases to the breast and from breast cancer. Familiarity of the dermatologist with the cutaneous manifestations of breast cancer will facilitate the diagnosis of breast malignancy and assist with staging, prognostication, and evaluation for recurrence. This article also discusses genodermatoses that predispose to breast pathology and provides imaging recommendations for evaluating a palpable breast mass.
Topics: Breast; Breast Diseases; Breast Neoplasms; Disease Management; Female; Genetic Predisposition to Disease; Humans; Male; Nipples
PubMed: 30452954
DOI: 10.1016/j.jaad.2018.08.066 -
Annals of Plastic Surgery May 2024After breast surgery, patients experience significant alterations to breast sensation, which can diminish quality of life. Nerve coaptation technique, introduced in the... (Review)
Review
BACKGROUND
After breast surgery, patients experience significant alterations to breast sensation, which can diminish quality of life. Nerve coaptation technique, introduced in the 1990s, has gained traction in recent years. We performed a scoping review of the literature to determine the available outcomes in sensate breast reconstruction.
METHODS
The review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews statement guidelines. EMBASE and PubMed databases were queried using standardized terminology. Studies were included if they reported original sensory outcomes following innervation techniques during breast reconstruction and were published from January 1, 1990, to April 18, 2022. Data extraction and analyses were performed on Microsoft Excel.
RESULTS
From 602 screened articles, 27 studies met the inclusion criteria. Innervated autologous reconstructive procedures were described in 24, whereas the remaining 3 (all published after 2019) described direct reinnervation of the nipple-areola complex. Most (88.9%) of the studies comparing innervated versus noninnervated reconstruction reported improved sensory outcomes in at least 1 modality. Two studies investigated patient-reported outcomes using validated questionnaires, both of which reported improvement with innervated reconstruction.
CONCLUSIONS
Sensate breast reconstruction has the potential to improve outcomes for patients. There is a recent progressive increase in studies involving direct nipple-areolar reinnervation. Larger, prospective studies are needed to better characterize the quality-of-life outcome using validated scales, as well as evaluate sensory and patient-reported outcomes with implant and autologous reconstruction.
Topics: Humans; Mammaplasty; Female; Quality of Life; Breast Neoplasms; Nipples; Mastectomy; Breast
PubMed: 38685499
DOI: 10.1097/SAP.0000000000003832 -
Plastic and Reconstructive Surgery Feb 2023Preoperative vascular mapping has been demonstrated to be an excellent adjunct to perforator flap surgery by reducing operative times and enhancing surgical precision....
BACKGROUND
Preoperative vascular mapping has been demonstrated to be an excellent adjunct to perforator flap surgery by reducing operative times and enhancing surgical precision. This study evaluated the benefit of preoperative vascular mapping using magnetic resonance imaging and Doppler ultrasonography to identify the different perforators to the breast and compared it to postoperative mapping. The authors' intent was to determine whether preoperative knowledge of the various vascular sources to the nipple-areola complex affected the outcome and vitality of the nipple-areola complex.
METHODS
A prospective study was performed on 15 patients undergoing 25 nipple-sparing mastectomies for breast cancer or genetic predisposition. Ten patients underwent bilateral mastectomy, and five underwent unilateral mastectomy. Mean age was 52 years (range, 30 to 76 years). The mean patient body mass index was 22.4 kg/m2 (range, 20 to 35 kg/m2). Inclusion criteria consisted of breast cancer or genetic predisposition and grade 1 or 2 breast ptosis. Exclusion criteria included prior breast surgery, grade 3 ptosis, and gigantomastia. All patients underwent immediate direct-to-implant reconstruction.
RESULTS
Preoperative vascular mapping by magnetic resonance imaging and external Doppler ultrasonography was performed in all 15 patients. In all 25 breasts, the fifth anterior intercostal artery perforator was identified preoperatively and preserved intraoperatively. Postoperative imaging demonstrated patency of the fifth anterior intercostal artery perforator vessels in all patients. Nipple-areola viability was demonstrated in all breasts.
CONCLUSIONS
This study demonstrates that preoperative magnetic resonance imaging and Doppler ultrasonography for mapping breast perforator vessels is a useful strategy and should be considered for select patients undergoing nipple-sparing mastectomy. Identification of dominant perforators to the breast allowed mastectomy planning with preservation of the important perforator to the mastectomy skin flaps and nipple-areola complex.
CLINICAL QUESTION/LEVEL OF EVIDENCE
Therapeutic, IV.
Topics: Humans; Middle Aged; Female; Nipples; Mastectomy; Breast Neoplasms; Prospective Studies; Genetic Predisposition to Disease; Mastectomy, Subcutaneous; Perforator Flap; Mammaplasty; Retrospective Studies
PubMed: 36696303
DOI: 10.1097/PRS.0000000000009824 -
Aesthetic Plastic Surgery Jun 2021Nipple-areolar tattooing is well accepted as part of breast reconstruction, but the clinical data on its safety and patient satisfaction after the procedure are...
BACKGROUND
Nipple-areolar tattooing is well accepted as part of breast reconstruction, but the clinical data on its safety and patient satisfaction after the procedure are insufficient. We aimed to evaluate the complications of and patient satisfaction after nipple-areola tattooing in Japanese post-mastectomy breast reconstruction patients.
METHODS
Patients who visited our center after undergoing nipple-areola tattooing from January 2017 to March 2020 were given an unmarked questionnaire with questions about complications related to their nipple-areola tattoo. Patients' registered their subjective evaluation responses regarding nipple-areola appearance using visual analog scale and that regarding overall satisfaction using 5-point Likert scale and free-text responses. Patients who were followed up within 6 months after tattooing or those with incomplete data were excluded.
RESULTS
Sixty-two patients (average age: 49.7 ± 9.8 years), with an average post-tattooing period of 21.2 ± 10.5 months, were included. No patient had infections or allergic reactions. The average VAS score for nipple-areola appearance was high (8.5), and 59 patients (95.3%) answered that they were satisfied. In the free-text patient responses, 25 patients answered that they now felt comfortable going to the hot spring or taking a bath with their children, and 19 patients reported improved mental health after the procedure.
CONCLUSION
Post-breast reconstruction nipple-areola tattooing with sterilized inorganic pigments could achieve high esthetics and patient satisfaction, without serious complications. It is recommended for Japanese individuals with a culture of visiting hot springs and public baths.
LEVEL OF EVIDENCE IV
This journal requires that authors assign a level of evidence to each submission to which evidence-based medicine rankings are applicable. This excludes review articles, book reviews, and manuscripts that concern basic science, animal studies, cadaver studies, and experimental studies. 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: Adult; Breast Neoplasms; Child; Humans; Mammaplasty; Mastectomy; Middle Aged; Nipples; Patient Satisfaction; Retrospective Studies; Surveys and Questionnaires; Tattooing; Treatment Outcome
PubMed: 33112992
DOI: 10.1007/s00266-020-02018-0