Nipple-sparing mastectomy: Where are we now?
ABSTRACT Surgical treatment of breast cancer has evolved from radical mastectomy with routine removal of the nipple-areolar complex (NAC) to breast conservative therapy with preservation of the breast and NAC. When breast conservation is not appropriate or the patient desires mastectomy for risk reduction, conventional therapy still consists of mastectomy with removal of the NAC, followed by reconstruction. Rising interest in improved cosmesis has led to the introduction of the skin-sparing and nipple-sparing mastectomy (NSM) as potential alternatives to mastectomy. There has been much controversy regarding the oncologic safety of these procedures, and the NSM has also introduced a set of complications, such as nipple and areolar necrosis, that are not a concern with total mastectomy. From our review of the literature, we feel that NSM may be a viable option in the appropriate setting, and that its risks and complications are acceptable when compared to the traditional surgical treatment of breast cancer.
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ABSTRACT: Oncologic, reconstructive, and cosmetic breast surgery has evolved in the last 20 years. Familiarity with cutting-edge surgical techniques and their imaging characteristics is essential for radiologic interpretation and may help avert false-positive imaging findings. Novel surgical techniques include skin- and nipple-sparing mastectomies, autologous free flaps, autologous fat grafting, and nipple-areola-complex breast reconstruction. These techniques are illustrated and compared with conventional surgical techniques, including modified radical mastectomy and autologous pedicled flaps. The role of magnetic resonance (MR) imaging in surgical planning, evaluation for complications, and postsurgical cancer detection is described. Breast reconstruction and augmentation using silicone gel-filled implants is discussed in light of the Food and Drug Administration's recommendation for MR imaging screening for "silent" implant rupture 3 years after implantation and every 2 years thereafter. Recent developments in skin incision techniques for reduction mammoplasty are presented. The effects of postsurgical changes on the detection of breast cancer are discussed by type of surgery. ©RSNA, 2014.Radiographics 05/2014; 34(3):642-60. DOI:10.1148/rg.343135059 · 2.73 Impact Factor
Article: 5 BREAST PROCEDURES[Show abstract] [Hide abstract]
ABSTRACT: The procedures used to diagnose, stage, and treat breast dis-ease are rapidly becoming less invasive and more cosmetically satisfying while remaining oncologically sound. In particular, percutaneous core biopsy has largely replaced excisional breast biopsy for both palpable and nonpalpable breast lesions and has proved to be an equally accurate, less invasive, and less costly means of pathologic diagnosis. 1 Moreover, in clin-ically appropriate patients, sentinel lymph node biopsy (SLNB) has proved to be an accurate method of staging the axilla that reduces the incidence of many of the complications associated with traditional axillary node dissection. 2 Further-more, breast conservation has largely supplanted mastectomy for defi nitive surgical treatment of breast cancer; randomized trials continue to demonstrate equivalent survival rates for the two therapies. 3 Even in those cases where mastectomy is either required or preferred, advances in reconstructive tech-niques have been made that yield signifi cantly improved out-comes after breast reconstruction. 4 Finally, in an effort to eliminate the need for open surgical treatment of breast cancer, various percutaneous extirpative and ablative local therapies have been developed and are being evaluated for potential use in managing breast cancer in carefully selected patients. 5 A more minimally invasive approach to breast disease will depend to a substantial extent on the availability of accurate and effi cient imaging modalities. Adeptness with such modal-ities is rapidly becoming an essential part of the general sur-geon's skill set. In this chapter, we describe selected standard, novel, and investigational procedures employed in the diagno-sis and management of breast disease. The application of these procedures is a dynamic process that is shaped both by tech-nological advances and by physicians' evolving understanding of the biology of breast diseases. Breast Ultrasonography Breast ultrasonography can be useful for evaluating palpable breast masses or mammographically indeterminate lesions; for carrying out postoperative and oncologic follow-up; for guid-ing aspiration and biopsy of lesions; and for facilitating intra-operative tumor localization, margin assessment, placement of catheters for partial-breast irradiation, and investigational tumor-ablating techniques. In the offi ce, breast ultrasonography has become a useful adjunct to the clinical breast examination, particularly in patients with radiographically dense mammograms. It defi nes breast lesions more clearly than physical examination does and thus can potentially reduce the number of unnecessary biop-sies done for simple cysts or fi broglandular tissue presenting as a palpable nodularity. Whole-breast ultrasonography is not an effective screening tool and therefore should not be a substitute for annual mammography. The American College of Surgeons (ACS) and various surgical subspecialty organi-zations offer a multitude of courses, at varying skill levels, geared toward training general surgeons in the use of breast ultrasonography.
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ABSTRACT: The role of surgery has been continuously evolving for the last 100 years, as have the various techniques for the management of breast cancer. Thanks to the results of well-designed randomized control trials, the mutilating radical mastectomies of the past came to be gradually replaced by modified techniques and, eventually, by local excisions combined with radiotherapy without compromising prognosis and survival. The purpose of this approach was to minimize morbidity and avoid unnecessary harm and burden to the patients. Conserving the breast was a start, but up to a decade ago the techniques used were limited to just cancer excision and closure of the wound, leaving behind a mutilated breast in many women. The introduction and evolution of oncoplastic surgery completely changed the modern surgical approach to breast cancer, taking the development to the next level. The concept of oncoplastic breast surgery combines oncologic tumour resection, in the form of either breast conservation or mastectomy, with traditional or modified plastic surgical techniques aiming to achieve an optimal cosmetic result with long-term local tumour control Eventually, what used to be a simple yet frequently mutilating removal of the cancerous breast lesion became a sophisticated, though often technically demanding, quality-of-life-oriented part of the multidisciplinary process in the treatment of cancer that nowadays affects almost 1 out of 9 women. In this review article, we present the basic principles, elements and techniques of oncoplastic breast surgery. We further discuss the indications, contraindications, advantages and disadvantages of these techniques.Hellēnikē cheirourgikē. Acta chirurgica Hellenica 04/2012; 84(2). DOI:10.1007/s13126-012-0011-3