Nipple-areola Complex Research Articles

A nurse-led multidisciplinary service for Nipple-Areola complex tattooing after breast cancer: reporting on a complex intervention with TIDieR analysis

BackgroundThe Nipple-Areola Complex (NAC) tattooing can restore physical and mental integrity after breast cancer, but it is not always easily accessible for women. This paper aims to report on the development of a multidisciplinary nurse-led service for NAC tattooing for women who underwent breast cancer surgery with NAC removal to allow its thorough review and replication.MethodsThe Medical Research Council’s framework for developing complex healthcare interventions was followed. According to the results of a literature review, and the context analysis, an initial intervention was planned. The Template for Intervention Description and Replication checklist was chosen to ensure the quality and completeness of the intervention description.ResultsThe Breast Unit and the Research departments were engaged; three nurse-tattooists were selected; the informative material was created and shared with patients, families and local associations, involving them actively. Finally, the setting and the materials were defined. A monthly schedule of activities was set: patients with the indication for NAC tattooing were contacted by the nurse case manager. Each treatment involves 3–4 sessions, 30–40 days apart, in an ambulatory setting. It consists of NAC shaping and tattooing with a dermographer and sterile needles.ConclusionImplementing freely and equally multidisciplinary nurse-led clinics might provide this treatment ensuring the patient’s quality of life and nurse competence. The NAC tattooing is a complex intervention that represents the final part of the breast cancer surgical care pathway.

Preventing Bird’s Beak Deformity: A narrative review of Innovations in Oncoplastic Surgery

Background: In the field of breast surgery, breast conserving surgery (BCS) is widely valued for its ability to preserve the breast while also achieving cosmetically acceptable outcomes and an overall survival rate comparable to that of total mastectomy. However, BCS has not always managed to achieved satisfactory cosmetic results. Among its challenges is the “bird’s beak” deformity, which is characterized by skin retraction and a downward deviation of the nipple areolar complex due to tissue excision from the lower pole of the breast. Methods: Various forms of oncoplastic surgery (OPS) have been developed to prevent bird’s beak deformity. These include volume displacement operations (such as superior pedicle mammoplasty, rotation technique and downward-mobilization procedure), as well as volume replacement techniques, including the latissimus dorsi mini-flap, thoracodorsal artery perforator flap, lateral intercostal artery perforator flap, anterior intercostal artery perforator flap, inframammary adipofascial flap and lipofilling. Conclusion: Choosing the most suitable approach for OPS requires careful consideration of various factors, notably the defect’s size and location, the size of the breast, and the thickness of subcutaneous fatty tissue. Further studies are required to firmly position these forms of OPS techniques in an evidence-based framework.

Indocyanine Green Angiography-Assisted Pure Hemi-Periareolar Incision Nipple-Sparing Mastectomy and Direct-to-Implant Breast Reconstruction.

Although pure hemi-periareolar incisions for mastectomy can prevent visible scarring, nipple-areolar complex (NAC) necrosis is a potential risk. Superficial-arterial inflow of the NAC can be evaluated by indocyanine green angiography (ICG-A). This study evaluated the impact of ICG-A assisted periareolar incision on NAC necrosis during nipple-sparing mastectomy (NSM) and direct-to-implant (DTI) breast reconstruction. Between December 2018 and November 2021, lateral hemi-periareolar incisions for NSM were routine. After that time, ICG-A-assisted hemi-periareolar incisions were performed between December 2021 and Sept. 2023. The location of the main arterial inflow was evaluated during preoperative ICG-A and the periareolar incision was planned to avoid disruption. NAC necrosis in the ICG-A-assisted and blind-incision groups was compared using univariate and multivariate analyses. A total of 202 breasts were analyzed including 80 breasts from 75 patients in the ICG-A-assisted group and 122 breasts from 115 patients in the blind-incision group. On preoperative ICG-A, superficial-arterial inflow was observed in 67 of 80 (83.75%) breasts. Perfusion of the nipple without superficial-arterial inflow (base-perfusion pattern) was observed in 13 breasts (16.25%). The main arterial inflow was most common in the upper-medial direction at the areolar margins (65.67%). The full-thickness NAC necrosis rate in the ICG-A-assisted incision group was significantly lower than that in the blind-incision group (2.5% vs. 13.1%, p = 0.010). Multivariate analysis demonstrated that ICG-A-assisted incisions significantly reduced the risk of NAC necrosis (odds 0.155, p = 0.030). ICG-A-assisted pure hemi-periareolar incisions reduced NAC necrosis in DTI breast reconstructions.

Comparative Outcomes of Superomedial and Inferior Pedicles in Breast Reduction and Mastopexy: A Meta-Analysis of 5123 Breasts.

Superomedial and inferior pedicles are two commonly used techniques in breast reduction and mastopexy. This systematic review and meta-analysis aims to compare the clinical outcomes associated with these two techniques. PubMed, Scopus, and Web of Science were searched for relevant studies. We included all studies with data comparing superomedial and inferior pedicles. Statistical analyses were performed using RevMan version 5.4. The search yielded 1075 studies, of which 15 were included in the meta-analysis, encompassing 2633 patients (5123 breasts), with 3491 breasts receiving superomedial pedicles and 1632 breasts receiving inferior pedicles. Superomedial pedicles were associated with significantly shorter operative length (MD = - 24.71, 95% CI = - 37.63 to - 11.79, p = 0.0002), higher BREAST-Q breast satisfaction scores (MD = 10.34, 95% CI = 7.72 to 12.96, p < 0.00001), lower infection rates (RR = 0.46, 95% CI = 0.24 to 0.86, p = 0.02), higher incidence of seroma (RR = 3.00, 95% CI = 1.15 to 7.79, p = 0.02), and higher incidence of decreased nipple-areola complex (NAC) sensation (RR = 1.50, 95% CI = 1.12 to 2.01, p = 0.006). No significant differences were observed in asymmetry, fat necrosis, NAC loss, and hematoma. Superomedial pedicles demonstrated higher incidences of decreased NAC sensation and seroma formation, lower incidence of infection, shorter operative length, and higher BREAST-Q breast satisfaction scores compared to inferior pedicles. Further research is needed to confirm these findings and explore the long-term aesthetic outcomes associated with both techniques. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Staged Nipple Delay Procedure Expands Candidacy for Nipple-Sparing Mastectomy.

Nipple delay (ND) is a staged procedure that improves nipple-areolar complex (NAC) viability in nipple-sparing mastectomy (NSM) patients who are high-risk for NAC or skin-flap necrosis. This study compared postoperative outcomes and risk factors between patients treated with ND-NSM and NSM alone. Patient demographics, risk factors for NAC or skin-flap necrosis, tumor characteristics, and operative outcomes were compared between ND-NSM and NSM groups from 2009 to 2023. Univariate and multivariate analyses were performed to identify significant variables associated with NAC or skin-flap necrosis. Overall, 71 ND-NSM patients and 537 NSM patients were compared. ND-NSM patients had larger breasts (p<0.01), body mass index ≥ 30 (p=0.01), prior breast/chest wall radiation (XRT) [p<0.01], prior breast operations (p<0.01), less axillary surgery (p<0.01), more autologous tissue reconstruction over implant-based reconstruction compared with NSM patients (p=0.02), and more prophylaxis (p<0.01). There were no statistically significant differences between groups in regard to infection, skin-flap necrosis, NAC necrosis, seromas, and hematomas. No patients in the ND-NSM group had NAC necrosis and 1 patient had skin-flap necrosis, compared with 17 and 13 patients in the NSM group, respectively (p=0.24). On univariate analysis, prior XRT was associated with increased risk for skin-flap necrosis (p=0.02). Multivariate analysis showed XRT was associated with skin-flap necrosis (p=0.02) and any necrosis (p=0.01). Breast size was associated with NAC or skin-flap necrosis (p=0.04). Larger breasts and XRT were risk factors for NAC or skin-flap necrosis; however, despite having more risk factors, ND-NSM patients had very low rates of necrosis. Notably, no nipples were lost. A shared decision should be made with patients regarding the risks and benefits of ND-NSM.

Evaluation of Breast Skin/Nipple–Areolar Complex Sensation and Quality of Life after Nipple-Sparing Mastectomy Followed by Reconstruction

Background and Objectives: Sensation of the breast skin and nipple–areolar complex (NAC) is commonly assumed to be diminished or completely absent following nipple-sparing mastectomy (NSM) with implant- or expander-based reconstruction. The purpose of this cohort study was to evaluate breast skin and NAC long-term touch pressure sensibility, from 1 month to 1 year, after NSM followed by reconstruction with an implant or expander, and patient quality of life (QoL), hypothesizing that sensibility may diminish with a small progressive return throughout the postoperative period. Materials and Methods: This was achieved by performing sensation tests using Semmes–Weinstein monofilaments (SWM) in nine predefined points of the breast and NAC, a two-point discrimination test (TPD) in the four quadrants of the breast, and QoL assessment using the BREAST-Q. We evaluated 42 patients in Pauls Stradiņš Clinical University Hospital, with a total of 66 breasts, who underwent NSM between 2021 and 2023, performing the breast sensation tests before surgery and postoperatively at 1/3/6 months and 1 year. The BREAST-Q was administered to assess patient satisfaction and well-being. Results: Our results reflect a decline in breast skin and NAC sensation in the 1-month evaluation after NSM (mean: 4.67) when compared to the assessment before surgery (mean: 2.57), with a small progressive return reflected in the 3 months (mean: 3.79), 6 months (mean: 3.68), and 1-year evaluations (mean: 3.14). The following were the mean scores obtained from the BREAST-Q: Psychosocial Well-being (mean: 66), Sexual Well-being (mean: 50), Satisfaction with Breasts Pre-OP (mean: 58), satisfaction with breast reconstruction (mean: 52), Satisfaction with Implants, Satisfaction with nipple reconstruction, Physical Well-being Chest, Adverse effects of radiation, and Satisfaction with Information. Conclusions: This study confirms that sensibility diminishes after this procedure, as observed when comparing the sensation evaluation results before the operation with the 1-month evaluation, reflecting a small progressive return in the following months.

Nipple-Areola Complex Reconstruction Using FixNip NRI Implant after Mastectomy: An Innovative Technique.

Nipple-areolar complex reconstruction is the final stage of breast reconstruction, and it improves quality of life in patients with post-mastectomy breast cancer. We present a case of a patient with breast cancer underwent breast reconstruction and subsequent nipple-areolar complex reconstruction with an innovative biocompatible smooth silicone implant specially designed for a long-lasting restoration of the nipple-areola complex called FixNip NRI. However, to our knowledge, nipple-areolar complex reconstruction with FixNip was not previously reported. We present an emerging technique applied on a patient with breast cancer treated with skin-sparing mastectomy and with immediate breast reconstruction using an expander and then exchanged expander to breast implant. FixNip nipple reconstruction implant is implanted for the reconstruction of the areola-nipple complex with local-regional anaesthesia. She did not develop any postoperatively short-term or long-term complications, and her nipple slowly underwent to a gradual and better definition of its profile. This new approach regarding the reconstruction of the nipple-areola complex seems to be very promising in relation to both the degree of aesthetic satisfaction of patients and the ease of use by surgeons. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Primary Breast Necrotising Fasciitis in an Elderly Woman Managed with Nipple–Areola Conservation and Delayed Primary Closure in a Resource-Poor Setting A Case Report

Abstract Primary breast necrotising fasciitis is a rare disease that can rapidly progress with high morbidity and mortality rates. Due to its rare occurrence, it is often misdiagnosed. This case was a 65-year-old, obese, immobile, and newly diagnosed woman who presented with a 2-week history of progressive left breast pain and swelling with associated darkening of the breast skin and discharge of foul-smelling fluid. There was no history of fever and the nipple–areola complex was spared. The surrounding healthy skin has a characteristic peau d’orange and erythematous. Two discrete and slightly tender left axillary lymph nodes were noted. At the presentation, her blood sugar was high. Initially, a breast malignancy was suspected but later an ultrasound showed increased fibrous and fatty tissue architecture of the mammary gland. It also noted inflammatory collections within the mammary glands and thus concluded breast inflammation. Early intervention with antibiotic cover and wound debridement forestalled the progress of the disease and nipple–areola salvage. The wound was later covered by delayed primary closure after 14 days of wound dressing with a silver-based solution. Breast asymmetry was noted as a surgical complication. Early aggressive intervention in necrotising fasciitis of the breast in an elderly woman with comorbidities contributed to the preservation of nipple–areola complex with eventual satisfactory management using direct wound closure.

Modified McKissock Technique for Secondary Breast Reduction - A Prospective Study on Safety, Surgical and Aesthetic Outcomes.

Numbers of secondary breast reductions are increasing but those are potentially associated with higher complication rates than primary mammaplasty. Necrosis of the Nipple-Areola-Complex (NAC) is a devastating complication that can occur after repeated NAC transposition, particularly when the initially used pedicle is unknown. Thus, the authors established a modification of McKissock's technique for secondary breast reductions including three pedicle components to ensure safe vascular supply of the NAC. The presented technique incorporates a superior and inferior dermoglandular pedicle according to McKissock and an additional central pedicle. The technique was applied for secondary breast reduction in a series of 25 breasts (14 patients: 11 bilateral, 3 unilateral). Complication rates, pre- and postoperative BREAST-Q scores, and aesthetic outcomes were evaluated. Mean resection weight was 299 g (range, 40-646), and the NAC was transposed by 4.2 cm on average (range, 1-10). No case of NAC-necrosis was observed, and comparison of pre- and postoperative BREAST-Q values indicated substantial improvement in all domains. Postoperatively, 84.6% of patients reported excellent satisfaction with breast appearance. According to those results, the modified McKissock-technique is a safe technique for patients requiring secondary breast reduction, even if the primarily used pedicle is unknown. Additionally, the established technique is associated with improved postoperative patient-reported outcomes and yields aesthetically favorable results.

Algorithm postmastectomy breast reconstruction secondary to breast cancer in a reference center in Mexico City

Background: Postmastectomy breast reconstruction represents a challenge for the plastic surgeon. Contemporary techniques offer numerous options, the reconstructive procedure performed depends on the individual profile of each patient, but will also be influenced by the surgeon's preoperative analysis of their individualized risk profile. Methods: Descriptive, longitudinal, and retrospective study. The reconstructed patients with breast cancer sequelae in the period from May 2023 to May 2024 were included. Based on the review of the literature and the experience of our center, a proposal for a breast reconstruction algorithm was formulated to standardize the ideal surgical treatment according to the case. Results: 119 patients were reconstructed using the algorithm to decide the ideal surgical management. Breast reconstruction was performed in 3 stages: the first stage [1st BRS] (119 patients) consisted of a tissue expander, breast implant ± acellular dermal matrix or autologous pedicled flaps after the mastectomy; in the 2nd BRS (68 patients) the expander was replaced with an implant with or without contralateral symmetrization; and finally in the 3rd BRS (18 patients), the reconstruction of the nipple-areola complex ± neurotization, autologous fat transfer and scar remodeling was performed. Conclusions: The algorithm proposed in this paper provides a guide for making decisions about ideal surgical management according to the clinical characteristics of each subgroup of patients to be reconstructed, improving results by making them reliable and predictable, which positively impacts patient's quality of life.

A Unique Case of Unilateral Pseudogynecomastia.

Gynecomastia is a common condition characterized by the benign enlargement of male breast tissue, often resulting from hormonal imbalances. A rare variant, unilateral pseudogynecomastia, involves enlargement due to adipose tissue accumulation without glandular proliferation and can be associated with occupational factors. We report the case of a 45-year-old male mechanic presenting with unilateral enlargement of the left breast. The patient reported daily microtrauma on his left axilla and chest wall. The clinical evaluation and imaging revealed lipomatosis with pronounced fibrous tissue and no glandular tissue involvement. The hormonal assays were within the normal limits. The patient underwent surgical excision of excess adipose tissue using the Kornstein technique, preserving the nipple-areola complex. The histopathological examination confirmed the absence of malignancy. The postoperative recovery was uneventful, and the follow-up examination at 12 months demonstrated a symmetrical breast appearance with no recurrence. This case underscores the importance of differentiating pseudogynecomastia from true gynecomastia and recognizing potential occupational risks. Surgical management using techniques that preserve the nipple-areola complex can achieve excellent cosmetic outcomes.

Modified peri-areolar mastopexy and fat grafting in complex breast ptosis: A randomized open-label controlled trial

BackgroundComplex breast ptosis may be caused by moderate and severe degrees of skin and glandular sagging associated with breast' and nipple-areola complex (NAC) asymmetries and deformity. The use of traditional peri-areolar mastopexy (t-PM) with or without implants is limited only for mild or moderate breast ptosis. ObjectivesThis article aims to report the safety and efficacy of the modified peri-areolar mastopexy (m-PM) characterized by a vertical shift of the classical pattern with implants and fat grafting (FG) in complex breast ptosis also evaluating the influence of breast and NAC asymmetries, breast, and chest deformities in the aesthetics outcomes. MethodsAn open label randomized controlled trial was performed. 40 women (study group - SG) affected by breast ptosis (moderate, and severe), asymmetries, and deformities were treated with m-PM, implants, and FG, comparing outcomes with those of a control group (CG) (n = 35) treated with t-PM and implants. Aesthetic outcomes were evaluated through the patient’s satisfaction grade, the physician's assessment score, and the visual Analog Scale (VAS). Results75% (n = 30) of SG patients reported excellent results on breast lift, shape, volume, NAC position, and scar quality after 12 months, while the CG reported the same outcomes in 60% (n = 21) of cases. SG patients showed a vertical NAC shift and a satisfaction degree higher than in the CG (p < 0.001 vs. CG). ConclusionsThe m-PM with implants and FG was safe and effective in this trial.

Long-Term Outcome of Surgery for Grade 4 Gynecomastia: A Single-Center Experience

Abstract Background Gynecomastia results in a feminine appearance of the male chest, leading to social embarrassment and loss of self-esteem in the afflicted males. Grade 4 gynecomastia is expected to have less than perfect results with liposuction and gland excision alone. This study was done to assess the long-term outcome of this surgery for grade 4 gynecomastia. Materials and Methods From January 2021 to December 2022, 81 patients with grade 4 gynecomastia were treated by us. All the patients underwent vibration amplification of sound energy at resonance (VASER) and suction-assisted liposuction of the chest and side rolls with excision of the gland with crescentic lift in the cases with ptosis. A retrospective study was done to analyze the long-term surgical outcomes in these patients by review of clinical records. Results Symmetry was achieved in 37/39 patients with grade 4a gynecomastia but only in 33/42 patients with grade 4b gynecomastia. The inframammary fold disappeared in 35/39 patients with grade 4a gynecomastia but only in 25/42 of grade 4b gynecomastia patients. Ptosis was corrected in 35/42 grade 4b gynecomastia patients. The mean follow-up was 15 months (range: 12–24 months). Only seven patients desired a second stage to correct the remaining deformity. Conclusion Liposuction with gland removal alone in grade 4a gynecomastia and with liposuction with crescentic nipple–areola complex (NAC) lift in patients of grade 4b gynecomastia give satisfactory results in patients with massively enlarged breasts. While grade 4a gynecomastia has overall better results and lesser complications as compared with grade 4b gynecomastia, the latter also has acceptable outcomes. Realistic prognosis needs to be explained to the patient preoperatively.

Pilot robotic mastectomy in Singapore (PRoMiSing I) study: first safety and feasibility prospective cohort trial in South East Asia.

Robotic mastectomy has been performed worldwide since 2015. The advantages of the robotic approach in nipple-sparing mastectomy have been proven with better visualization and preservation of blood supply to the nipple-areolar complex, with a lower incidence of necrosis. It also allows smaller incisions for both mastectomy and immediate breast reconstruction. To date, no centers in Singapore and Southeast Asia offer robotic mastectomy. We believe that robotic mastectomy is a feasible and safe technique that our population can utilize. This study aimed to ascertain the surgical outcomes and perform a learning curve analysis in patients undergoing robotic mastectomy in a multi-ethnic South East Asian population. A single-arm prospective pilot study of eligible patients aged 21-70 years old with early breast cancer or high-risk patients indicated for risk-reducing mastectomy who were eligible and consented to robotic mastectomy were enrolled in this trial from December 22, 2022 to December 15, 2023. A total of 29 consecutive robotic mastectomies were performed. The mean total operative time was 95±10.2min. The average blood loss was 5.7±1.9ml, and the average length of stay was 1.05 days. The mean mastectomy specimen weight was 251g, and there was no conversion to conventional mastectomy in any case. Furthermore, there were no 30-day morbidity or complications in terms of wound infection requiring intervention, flap, and nipple-areolar complex necrosis, and postoperative hematoma/bleeding requiring intervention. This study contributes to the current evidence that robotic mastectomy is a safe and feasible option and could prove to be a great alternative to conventional mastectomy. Further prospective trials examining the long-term oncological outcomes of robotic mastectomy will be performed to establish the oncologic safety of this technique in breast cancer treatment.

Learning Curve for Performing Targeted Nipple Areola Complex Reinnervation (TNR) for Gender Mastectomy- Moving from Nerve Graft Reconstruction to Direct Nerve Coaptation

Learning Curve for Performing Targeted Nipple Areola Complex Reinnervation (TNR) for Gender Mastectomy- Moving from Nerve Graft Reconstruction to Direct Nerve Coaptation

Current status of prepectoral breast reconstruction in Argentina.

Breast cancer is among the most common cancers diagnosed in women, affecting one in eight women per year. Immediate implant-based breast reconstruction has emerged as the predominant approach for postmastectomy reconstruction, with a growing preference for the direct-to-implant (DTI) method over the traditional tissue expander technique. While conventionally, implants were typically positioned beneath the pectoralis major muscle, recent advancements have paved the way for implant placement above the muscle, in the prepectoral plane. Nipple-sparing mastectomy (NSM) and skin-sparing mastectomy (SSM) techniques can be combined with prepectoral breast reconstruction. The presence of sufficient fatty tissue coverage is considered one of the foremost independent factors influencing the success of immediate breast reconstruction and flap viability. DTI is a safe approach for prepectoral implant-based reconstruction with a number of advantages. However, careful patient selection and judicious assessment of flap perfusion help identify an appropriate subset of patients for prepectoral DTI reconstruction. Proposed breast tissue coverage classification (BTCC) and rigorous perfusion assessment techniques will aid to minimize postoperative complications and reconstruction failure. Based on the obtained range of coverage values (distance between the Cooper's ligaments and the skin) of preoperative digital mammogram evaluation, a three-type BTCC is as follows: Type 1: <1 cm (poor coverage), Type 2: between 1 and 2 cm (medium coverage), Type 3: >2 cm (good coverage). Prepectoral DTI reconstruction provides good results with complication rates similar to those of subpectoral techniques, eliminating breast animation. A meticulous surgical technique is essential to preserve the vascular network that guarantees the survival of the skin flap and nipple-areola complex (NAC). In the good coverage group (Type 3), an immediate DTI reconstruction could be safely performed. Aesthetic complications as rippling can occur if prepectoral implants are placed in Type 1 patients. Preoperative planning for prepectoral placement should not depend on breast volume, but on breast tissue coverage. Flap evaluation based on preoperative imaging measurements may be helpful when planning a conservative mastectomy. Patient selection, preoperative and intraoperative mastectomy flap evaluation, and modifications in implant technology play a critical role in this new and rapidly growing method for implant-based breast reconstruction.

Minimal Access vs Conventional Nipple-Sparing Mastectomy

While nipple-sparing mastectomy (NSM) for breast cancer was only performed using the open method in the past, its frequency using endoscopic and robotic surgical instruments has been increasing rapidly. However, there are limited studies regarding postoperative complications and the benefits and drawbacks of minimal access NSM (M-NSM) compared with conventional NSM (C-NSM). To examine the differences in postoperative complications between C-NSM and M-NSM. This was a retrospective multicenter cohort study enrolling 1583 female patients aged 19 years and older with breast cancer who underwent NSM at 21 university hospitals in Korea between January 2018 and December 2020. Those with mastectomy without preserving the nipple-areolar complex (NAC), clinical or pathological malignancy in the NAC, inflammatory breast cancer, breast cancer infiltrating the chest wall or skin, metastatic breast cancer, or insufficient medical records were excluded. Data were analyzed from November 2021 to March 2024. M-NSM or C-NSM. Clinicopathological factors and postoperative complications within 3 months of surgery were assessed. Statistical analyses, including logistic regression, were used to identify the factors associated with complications. There were 1356 individuals (mean [SD] age, 45.47 [8.56] years) undergoing C-NSM and 227 (mean [SD] age, 45.41 [7.99] years) undergoing M-NSM (35 endoscopy assisted and 192 robot assisted). There was no significant difference between the 2 groups regarding short- and long-term postoperative complications (<30 days: C-NSM, 465 of 1356 [34.29%] vs M-NSM, 73 of 227 [32.16%]; P = .53; <90 days: C-NSM, 525 of 1356 [38.72%] vs M-NSM, 73 of 227 [32.16%]; P = .06). Nipple-areolar complex necrosis was more common in the long term after C-NSM than M-NSM (C-NSM, 91 of 1356 [6.71%] vs M-NSM, 5 of 227 [2.20%]; P = .04). Wound infection occurred more frequently after M-NSM (C-NSM, 58 of 1356 [4.28%] vs M-NSM, 18 of 227 [7.93%]; P = .03). Postoperative seroma occurred more frequently after C-NSM (C-NSM, 193 of 1356 [14.23%] vs M-NSM, 21 of 227 [9.25%]; P = .04). Mild or severe breast ptosis was a significant risk factor for nipple or areolar necrosis (odds ratio [OR], 4.75; 95% CI, 1.66-13.60; P = .004 and OR, 8.78; 95% CI, 1.88-41.02; P = .006, respectively). Conversely, use of a midaxillary, anterior axillary, or axillary incision was associated with a lower risk of necrosis (OR for other incisions, 32.72; 95% CI, 2.11-508.36; P = .01). Necrosis occurred significantly less often in direct-to-implant breast reconstruction compared to other breast reconstructions (OR, 2.85; 95% CI, 1.11-7.34; P = .03). The similar complication rates between C-NSM and M-NSM demonstrates that both methods were equally safe, allowing the choice to be guided by patient preferences and specific needs.

Feasibility and Accuracy of Ultrasound-Guided Core Needle Biopsy for Nipple Lesions: A Pilot Study.

Due to the superficial location, suspicious findings of the nipple-areolar complex (NAC) are not amenable to stereotactic or MRI-guided sampling and have historically necessitated surgical biopsy or skin-punch biopsy. There are limited reports of US-guided core biopsy of the nipple (US-CBN). We report our nearly 3-year pilot experience with US-CBN at an academic breast imaging center. An institutional review board-exempt and HIPAA-compliant retrospective review was performed. We assessed patient demographics, breast imaging characteristics, procedural data, pathology, and outcomes. Nine female patients aged 27 to 64 underwent US-CBN from January 2021 to October 2023. Initial imaging abnormalities included abnormal MRI enhancement, mammographic calcifications, and sonographic masses. After initial or second-look US, all imaging findings had sonographic correlates for biopsy specimens, the majority of which were sonographic masses (8/9). US-CBN was performed by 6 breast radiologists using a variety of devices. All biopsy specimen results were concordant with sonographic abnormalities, although 1 was considered discordant from the initial abnormality seen on MRI. There were no complications, and discomfort during the procedure was well-treated. Two patients (22%, 2/9) were diagnosed with malignancy. This pilot study demonstrated that US-CBN can be performed by a breast radiologist for definitive diagnosis of suspicious nipple abnormalities seen on breast imaging, avoiding surgery, and maintaining nipple integrity. In our population, 22% (2/9) of US-CBNs revealed malignancy.

Comparison of Oncological and Aesthetic Outcomes between Tissue Rearrangement Technique and Pedicled Latissimus Dorsi Flap Reconstruction in Cases of Upper Outer Quadrant Breast Cancer.

Emerging as an adjunct to breast-conserving surgery, oncoplastic breast surgery seeks to improve the cosmetic and functional outcomes for breast cancer surgery. The objective was to assess the potential advantages of using the latissimus dorsi (LD) flap, in comparison with local tissue rearrangement, in terms of aesthetic results and postoperative problems. This study compared the outcomes of patients with a malignant tumor removed from the upper outer quadrant of the breast using a comparative nonrandomized control approach. Participants were split into two groups: reconstruction using local tissue rearrangement was performed on 20 patients (group A), and a pedicled LD flap was used to treat the same number of patients (group B). All patients were examined in the clinics' outpatient setting. Every 3 months, the medical oncology team would do a thorough clinical assessment. Better aesthetic outcomes were significantly higher among patients with an LD flap. The LD flap was able to maintain breast shape in 90%, breast volume in 85%, and the nipple-areola complex direction in 90% of patients. Surgeons' evaluation of both techniques reported significantly higher satisfaction for LD flap than local tissue replacement. Patient satisfaction was significantly higher among patients with an LD flap. With regard to the postoperative complications, there were no significant differences between either group. Oncoplastic breast surgery with reconstruction using the pedicled LD flap provides maintenance of the shape of female breasts with better aesthetic outcomes and patient and surgeon satisfaction than reconstruction using local tissue rearrangement, with a comparable complication rate.

Topographic Analysis of the Nipple-Areolar Complex Sensation in Superomedial Pedicle Breast Reduction.

Surgeons meticulously perform breast reductions, while ensuring vascular integrity of the pedicle and Nipple-Areolar complex (NAC) to prevent any complication. It is crucial to remember that loss of sensation is also substantial complication, mainly due to unique characteristic features of the NAC. This study aimed to compare early and long-term sensory results by performing topographic analysis of NAC sensation after superomedial pedicle breast reduction. A prospective study was conducted by including nonrandomized female patients who underwent breast reduction surgery with wise pattern excision superomedial pedicle technique between January 2019 and June 2022. Semmes-Weinstein Monofilament (SWM) test performed at preoperatively, 3-6 months and 15-18 months postoperatively. NAC complex was divided into four equal quadrants and nipple: superomedial (SM), inferomedial (IM), inferolateral (IL), superolateral (SL) and Nipple (N). Touch-Test® Sensory Evaluator Chart was used to evaluate sensory results. None of the patients had any loss of sensation during preoperative SWM test. In postoperative 3-6 months, statistically significant differences were observed between N and SL (p = 0.002), SL and IM (p < 0.05), SM and IM (p < 0.05). In postoperative 15-18 months, there was no difference between the quadrants and nipple (p = 0.07). In early and long-term comparisons of the same quadrants, IL less pronounced than other quadrant comparisons (p = 0.034). A statistical difference was observed in overall NAC score (p < 0.05). It would be beneficial to inform patients overall NAC sensation in the postoperative may not be as good as preoperative, there might be variations in NAC sensation across different quadrants in early period. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .