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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.

Purpose:
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.
Methods:
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.
Results:
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.
Conclusions:
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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