Terminal Duct Lobular Units are Scarce in the Nipple: Implications for Prophylactic Nipple-Sparing Mastectomy

Department of Surgery, Tulane University, New Orleans, Louisiana, United States
Annals of Surgical Oncology (Impact Factor: 3.93). 03/2008; 15(2):438-42. DOI: 10.1245/s10434-007-9568-4
Source: PubMed


The use of nipple-sparing mastectomy (NSM) for both breast cancer treatment and risk reduction is increasing. There is no randomized data comparing nipple-sparing mastectomy with standard mastectomy techniques. There is evidence to suggest that ductal and lobular breast cancer arises in the terminal duct/lobular unit (TDLU). This study was undertaken to determine whether TDLUs exist in the nipple and if so, to what extent.
At the time of mastectomy the nipple papilla was excised and submitted for separate pathological examination. The presence or absence of TDLUs was noted.
Thirty-two nipples were studied in 22 patients. There were no TDLUs in 29 specimens. Three of 32 nipple specimens were found to contain TDLUs. The three nipples contain one, two, and three TDLUs respectively. All TDLUs were found at the base of the nipple, with none located near the tip.
The infrequent occurrence of TDLUs in the nipple papilla supports the use of NSM for risk reduction surgery, including for those women with BRCA1/2 mutations.

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Available from: Alan Stolier, Oct 06, 2014
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    • ". Voraussetzungen für eine NSM sind eine Tumorgröße unter 5 cm, ein Abstand von mindestens 2 cm zwischen Tumor und Mamille sowie ein negativer intraoperativer Gefrierschnitt des intramamillären Gewebezylinders (¼ Coring) [4]. Bei Einhalten dieser Standards ist von einer Lokalrezidivrate im Bereich des Nippel-Areola-Komplexes (NAC) von weniger als 2 % und bei prophylaktischer NSM von einer de-novo Krebsentstehung im NAC von unter 1 % auszugehen [5] [6]. "
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    ABSTRACT: Die operative Therapie des Mammakarzinoms spielt trotz der raschen Weiterentwicklung der systemischen Therapie noch immer eine zentrale Rolle. Bei mehr als zwei Drittel aller Patientinnen kann brusterhaltend operiert werden, wobei neben der onkologischen Sicherheit auch das resultierende kosmetische Ergebnis eine wichtige Rolle für die Patientinnen spielt. Daher ist es für Brustoperateure unumgänglich, sich mit den verschiedenen Methoden der Onkoplastik auseinanderzusetzen. Falls eine Mastektomie erforderlich ist, sollte das rekonstruktive Element von Anfang an angeboten und miteingeplant werden, da in vielen Fällen hautsparende Methoden und Sofortrekonstruktionen möglich sind. Although systemic treatment strategies are improving continuously, breast surgery still plays a central role in the management of breast cancer. Because breast conserving therapy is feasible in more than two thirds of breast cancer patients, breast surgeons should be aware of the different oncoplastic techniques. The development of skin sparing techniques combined with immediate reconstruction provides good cosmetic results in many cases in which mastectomy is required. Therefore the reconstructive element should be offered and integrated in the therapy plan as soon as mastectomy is indicated. SchlüsselwörterMammakarzinom-Operative Therapie-Onkoplastik-Rekonstruktion KeywordsBreast cancer-Breast surgery-Breast reconstruction
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    • "They also reviewed some of the literature on terminal ductal lobular units in the nipple. The incidence was reported to be between 9% and 17%, with most of the terminal ductal lobular units at the base of the nipple papilla.26 They cautioned against fixed-volume reconstructions after NSM because of a higher incidence of NAC necrosis. "
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    ABSTRACT: The use of areola-sparing (AS) or nipple-areola-sparing (NAS) mastectomy for the treatment or risk reduction of breast cancer has been the subject of increasing dialogue in the surgical literature over the past decade. We report the initial experience of a large community hospital with AS and NAS mastectomies for both breast cancer treatment and risk reduction. A retrospective chart review was performed of patients undergoing either AS or NAS mastectomies from November 2004 through September 2009. Data collected included patient sex, age, family history, cancer type and stage, operative surgical details, complications, adjuvant therapies, and follow-up. Forty-three patients underwent 60 AS and NAS mastectomies. Forty-two patients were female and one was male. The average age was 48.7 years (range, 28-76 years). Forty mastectomies were for breast cancer treatment, and 20 were prophylactic mastectomies. The types of cancers treated were as follows: invasive ductal (n = 19), invasive lobular (n = 5), ductal carcinoma-in situ (n = 15), and malignant phyllodes (n = 1). Forty-seven mastectomies (78.3%) were performed by inframammary incisions. All patients underwent immediate reconstruction with either tissue expanders or permanent implants. There was a 5.0% incidence of full-thickness skin, areola, or nipple tissue loss. The average follow-up of the series was 18.5 months (range, 6-62 months). One patient developed Paget's disease of the areola 34 months after an AS mastectomy (recurrence rate, 2.3%). There were no other instances of local recurrence. AS and NAS mastectomies can be safely performed in the community hospital setting with low complication rates and good short-term results.
    Preview · Article · Oct 2010 · Annals of Surgical Oncology

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