Authors
Shapovalov S.G.1, Kcheuso A.V.1, Khrustaleva I.E.2, Lazarenko E.S.1
1 Nikiforov’s All-Russian Center for Emergency and Radiation Medicine of the Emergencies Ministry of Russia, St. Petersburg
2 First St. Petersburg State Medical University named after I.I. acad. I.P. Pavlov, St. Petersburg
Abstract
Grounding: Breast cancer (BC) ranks first in the structure of oncological diseases in women. Their share among the working age is 60%. Fifteen years ago, the main surgical method of treating BC was mastectomy. This operation led to the disability of a woman, affecting the decrease in her social adaptation, and caused colossal psychological damage.
Purpose: to substantiate, on the basis of clinical observations, the indications for the reconstruction of the nipple-areolar complex (NAC) by the method of free autotransplantation in patients with breast cancer, to evaluate the safety of this technique. To compare the aesthetic results of autotransplantation of the NAC with delayed reconstruction of the NAC.
Materials and methods: Clinical examples of 3 patients who underwent surgical treatment for BC in 2021–2022 are given. All underwent simultaneous reconstruction of the mammary gland with replantation of the NAC.
Preoperative measurements included the distance from the sternal notch to the nipple (in cm), the distance from the nipple to the inframammary sulcus (in cm), the width of the base of the mammary gland (in cm), and the diameter of the NAC (in mm). The degree of ptosis was classified according to the classification systems of Regnault and Brink.
Results: Three clinical cases.
Conclusion: The technique of NAC autotransplantation in patients with breast cancer necessarily requires an intraoperative urgent histological examination of the submammary area and its subsequent planned histological examination. One-stage NAC autotransplantation is a safe and reliable method for patients for whom mastectomy with NAC preservation is contraindicated and is indicated in cases where the presence of tumor cells is excluded after an urgent histological examination of the submammary area.
Keywords: nipple-areolar complex, reconstruction, autotransplantation, breast cancer.
References
1. De Angelis R, et al. Breast cancer survivors in the United States: Geographic variability and times trends, 2005-2015. Cancer. 2009; 115: 1954-1966. doi: 10.1016%2FS1043-321X(09) 79395-6.
2. Malignant neoplasms in Russia in 2009 (morbidity and mortality). V.I. Chissov, V.V. Starinsky, G.V. Petrova, editors. M.: MNIOI named after P.A. Herzen, 2011. 260 p. (In Russ.)
3. Malignant neoplasms in Russia in 2018 (morbidity and mortality). A.D. Kaprin, V.V. Starinsky, G.V. Petrova, editors. M.: MNIOI named after P.A. Herzen, 2019. 250 p. (In Russ.)
4. Pusic AL, Matros E, Fine N, et al. Patient-Reported Outcomes 1 Year After Immediate Breast Reconstruction: Results of the Mastectomy Reconstruction Outcomes Consortium Study. J Clinical Oncology. 2017; 35(22): 2499-2503. doi: 10.1200%2FJCO.2016.69.9561.
5. Gerber B, Krause A, Dieterich M, Kundt G, Reimer T. The oncological safety of skin sparing mastectomy with conservation of the nipple-areola complex and autologous reconstruction: An extended follow-up study. Ann Surg. 2009; 249: 461-468. doi: 10.1097%2F01.SLA. 0000077922.38307.cd.
6. Jabor MA. Nipple-areola reconstruction: satisfaction and clinical determinants. Plast. Reconstr. Surg. 2002; 110: 457-463; discussion 464-465 Pusic AL, Matros E, Fine N, Bushe E, Gordillo GM, Hamill JB, Kim HM, Qi J, Albornoz C, Klassen AF, Wilkins EG. Patient-Reported Outcomes 1 Year After Immediate Breast Reconstruction: Results of the Mastectomy Reconstruction Outcomes Consortium Study. J Clinical Oncology. 2017; 35(22): 2499-2503. doi: 10.1200%2FJCO. 2016.69.9561.
7. Millard DR Jr, Devine J Jr, Warren WD. Breast reconstruction: A plea for saving the uninvolved nipple. Am J Surg. 1971; 122: 763-764. doi: 10.1016/0002-9610(71)90441-7.
8. A Review of 101 Consecutive Subcutaneous Mastectomies and Male Chest Contouring Using the Concentric Circular and Free Nipple Graft Techniques in Female-to-Male Transgender Patients. Plastic and Reconstructive Surgery. 2017; 139(6): 1262e.
9. Brink RR. Management of true ptosis of the breast. Plast Reconstr Surg. 1993; 91: 657-662. doi: 10.1097/PRS.0000000000003388.
10. Regnault P. Breast ptosis: Definition and treatment. Clin Plast Surg. 1976; 3: 193-203. doi: 10.1200%2FJCO.2016.69.9561.
