Nipple Resection and Reconstruction after Attempted Nipple-Sparing Mastectomy
Briar L. Dent, MD, Jerry Chao, MD, Daniel J. Eden, BS, Benjamin V. Stone, BA, Alexander Swistel, MD, Mia Talmor, MD.
New York-Presbyterian Hospital/Weill Cornell, New York, NY, USA.
Occult nipple malignancy is detected in 0%-58% of attempted nipple-sparing mastectomies (NSM), prompting excision of the involved nipple. We report our experience with nipple resection following attempted NSM and our outcomes with subsequent nipple reconstruction.
An IRB-approved retrospective review was performed of attempted NSM cases with immediate implant-based reconstruction from July 2006 to April 2015. Patients who underwent nipple excision were identified. Indications for excision, pathology reports, and reconstructive outcomes were reviewed.
568 NSMs were performed in 330 patients. 34 cases (6%) underwent nipple excision, 53% for positive frozen sections, 29% for positive permanent sections, 3% for clinical suspicion, and 15% either at patient request or for symmetry. All of the cases with positive frozen sections had disease on permanent section and 56% had residual disease in the resection specimen. Of the cases with positive permanent sections, frozen sections were negative in 50%, suspicious or atypical in 30%, and not sent in 20% of cases. 30% had residual disease in the resection specimen. Frozen section sensitivity was 64% (or 75% if suspicious and atypical findings are included). There were no false positive results on frozen section. 68% of cases have undergone nipple reconstruction by CV flap (57%), skate flap (39%), or nipple-sharing technique (4%). The aesthetic result following reconstruction was excellent in 83% of cases.
Our findings support the benefit of intraoperative sub-areolar frozen section for detection of occult disease. When nipple excision is required, patients can still achieve an excellent aesthetic result with nipple reconstruction.
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