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A Tumor Guided Incision Approach to Nipple Sparing Mastectomy: Outcomes and Implications for Reconstruction
Benjamin R. Eskenazi, MD
Emil J. Fernando, MD
Stephen Grobmeyer, MD
Risal Djohan, MD, MBA
Cleveland Clinic Foundation
2016-02-15
Presenter: Benjamin R. Eskenazi, MD
Affidavit:
I agree with the above statement
Director Name: Steven Bernard, MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Introduction:
Nipple sparing mastectomy (NSM) is an increasingly popular surgical approach for breast cancer patients. However, indications for NSM have been limited to tumors accessible via radial or infra-mammary incisions out of concern for oncologic and technical safety. This study examines an alternative approach to NSM based on tumor-guided incisions (TGI) utilizing intra-operative ultrasound and we report its oncologic and reconstructive outcomes.
Methods:
A retrospective chart review examined patients who underwent a NSM via an approach other than radial or infra-mammary incisions. Operative notes and postoperative photography confirmed TGI approach.
Results:
11 patients met the study criteria with an average age and BMI of 47.3 years and 24.1 kg/m2, respectively. Average tumor size was 1.8cm (range 0.6-3.3cm) with an average distance from the nipple-areola complex of 5.7cm (range 2-15cm). The average margin was 1.1cm with zero positive margins. 64% of the approaches were in the upper outer quadrant of the breast. 100% of patients underwent immediate tissue expander (TE) placement, 55% with Acellular Dermal Matrix (ADM). For final reconstruction, 27% underwent a free flap, 45% implant, and 27% are still pending. No cancer recurrence has been observed at a mean follow up of 12.2 months.
Conclusions:
TGI offers a valuable, oncologically sound alternative approach to traditional NSM incisions in patients who otherwise may have been excluded. The majority of tumors are in the upper outer quadrant, which usually deters the approach in conventional NSM. Reconstruction technique may include either free flaps or TE/Implant with or without ADM.
