Feasibility and safety of breast-conserving surgery via a periareolar incision for cancers located far from the nipple\u2013areolar complex: a retrospective study

Joohyun Woo,Woosung Lim,Se Hyun Paek,Jihae Lee

doi:10.1007/s00432-020-03385-6

Joohyun Woo, Woosung Lim + Show 2 more

Open Access

https://doi.org/10.1007/s00432-020-03385-6

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Abstract

PurposeWe performed breast-conserving surgery (BCS) using periareolar incisions for cancers located far from the nipple–areolar complex (NAC) and examined if BCS via a periareolar incision maximized cosmesis and maintained oncologic safety. One of the most important goals of BCS is to improve cosmesis after surgery and quality of life, but the skin incision can affect cosmesis based on the tumor location.MethodsFifty-five patients with breast cancers located far from the NAC underwent BCS via periareolar incisions between January 2017 and April 2018. If a sentinel lymph node biopsy was required, another skin incision was created in the axilla using the conventional technique. Medical records of patients were reviewed retrospectively.ResultsThe mean patient age was 48.1 ± 10.6 years. The mean tumor size was 1.8 ± 1.0 cm (range 0.2–4.5 cm) on preoperative magnetic resonance imaging (MRI); the mean distance from the NAC to the tumor was 5.9 ± 1.9 cm (range 4.0–12.3 cm). Patients with cancers in the subareolar area were excluded even though the distance from the nipple was > 4 cm on MRI. Negative microscopic margins were obtained in all patients. There was no surgical complication such as seroma, bleeding, or infection. Re-operation was not needed. All patients received whole breast radiation therapy. After surgery and radiation therapy, periareolar incision scars were nearly invisible.ConclusionFor cancers located far from the NAC, BCS via periareolar incisions is feasible and leads to superior cosmesis in selective patients. Moreover, BCS seems oncologically safe, although long-term outcomes need to be evaluated.

Highlights

Breast-conserving surgery (BCS) is a standard surgical treatment for localized breast cancer
A transverse incision directly over the cancer gives a good cosmetic result compared with a curvilinear incision, which is associated with distortion or asymmetry and always produces a scar
More than two-thirds of the patients had heterogeneously dense breast on mammography (Table 1). It was classified into 4 groups according to breast imaging-reporting and data system (BI-RADS)

Summary

Introduction

Breast-conserving surgery (BCS) is a standard surgical treatment for localized breast cancer. As surgeons usually place an incision in the breast over or near the cancer, the skin incision is dependent on the cancer location (Zollinger et al 2011). A curvilinear incision along the Langer’s lines or a transverse incision along the Kraissl’s lines, the natural skin lines of the breast, are usually used because they can be utilized irrespective of the location of the cancer in the breasts. The skin incision is important not considering the access to the cancer, but for cosmetic results. A transverse incision directly over the cancer gives a good cosmetic result compared with a curvilinear incision, which is associated with distortion or asymmetry and always produces a scar.

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