Application of mammary-duct exenteration of nipple-skin-sparing mastectomy for breast cancer:A prospective cohort study
Objective To investigate feasibility and preliminary oncological safety of surgical innovations in breast cancer patients who have undergone nipple-skin-sparing mastectomy(NSSM)for nipple discharge or central lesions and tumors that do not involve the nipple-areola skin.Methods Between May 2018 and November 2023,patients diagnosed with breast cancer presenting nipple discharge or lesions in the central area underwent NSSM.The imaging assessment revealed no involvement of the nipple-areola-skin by the tumor.We performed a surgical removal of the affected mammary duct and simultaneously made a circular incision measuring 3-4 mm in diameter at the apex of the nipple.The study also involved the collection of clinical data,early complications,oncological outcomes and conducting aesthetic analysis of the nipple using the BREAST-Q scale.Results The surgical procedure was conducted on a cohort of 39 female patients at age of 27-57(39.0±7.6)years.The postoperative pathological stages of breast cancer were distributed as follows:stage 0 in 2 patients(5.1％),stage Ⅰ in 1 patients(2.6％),Ⅱ A stage in 15 patients(38.5％),Ⅱ B stage in 21 patients(53.8％).Tumor type:simple carcinoma in situ in 5 patients(12.8％),invasive carcinoma in 14 patients(35.9％),including invasive carcinoma with carcinoma in situ in 20 patients(51.3％).During the median follow-up period of 15.0(2-66)months,3 patients(7.7％)developed decolorization caused by mild nipple ischemia;there was no nipple necrosis;1 patient(2.6％)failed nipple reconstruction(no milk column,the milk column disappeared due to external dressing compression after operation).There were no incision complications,subcutaneous emphysema or intramammary hematoma in all patients.Two patients(5.1％)underwent prosthesis removal and nipple areola excess skin resection because of prosthesis cavity infection and final exposure caused by debridement,dressing change,redrainage and so on.As of April 2024,no tumor recurrence or metastasis was found during the follow-up period.The satisfaction of patients with nipple was 97.4％according to BREAST-Q score.Conclusion The satisfaction of breast cancer patients diagnosed with nipple discharge or lesions in the central area,but without involvement of the nipple areola skin,and who underwent subcutaneous mastectomy with immediate reconstruction is significantly enhanced.Furthermore,there is no increased risk of tumor recurrence or metastasis in short-term.
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