To investigate the experience and efficacy of endoscopic thyroidectomy for papillary thyroid microcarcinoma (PTMC) through total areola approach.
 Methods: A total of 117 PTMC patients, who were diagnosed pathologically in Minimally Invasive Surgical Center, Second Xiangya Hospital, Central South University from June 2016 to December 2017, were divided into a endoscopic surgery group (n=72) and an open surgery group (n=45). The number of dissected central lymph nodes, blood loss, amount of drainage, occurrence of postoperative complication and recurrence were collected and compared.
 Results: Compared with the open surgery group, the blood loss was less and the operative time was longer in the endoscopic surgery group (P<0.05). There were no significant differences between the 2 groups in the number of dissected central lymph nodes, amount of drainage and occurrence of postoperative complication (all P>0.05). The mean follow-up time was more than 20 months, and there was no recurrence in the 2 groups. 
 Conclusion: Endoscopic thyroidectomy with central compartment neck dissection through total areola approach is safe and feasible in patients with PTMC. It has many advantages, such as no scar on neck, less blood loss, shorter hospital stay and more acceptable to young patients.
Carcinoma, Papillary ; surgery ; Endoscopy ; Humans ; Nipples ; Thyroid Neoplasms ; surgery ; Thyroidectomy

Acellular Dermis ; Female ; Humans ; Mammaplasty ; methods ; Nipples ; surgery

OBJECTIVE: To review the advances in methods for reconstructing nipple projection based on tissue graft support. METHODS: The literature related to nipple projection reconstruction based on tissue graft support was reviewed and summarized in terms of the advantages and disadvantages of various tissue grafts and the improved nipple projection results. RESULTS: Loss of nipple projection is a common cause of decreased patient's satisfaction. Reconstructing nipple projection based on tissue graft support is a more common clinical method and can be done with autologous and allogeneic tissues. Autologous tissue grafts include dermis, adipose tissue with dermis, adipose tissue, ear cartilage, rib cartilage, and contralateral nipple tissue. Autologous tissue grafts are easy to obtain and have no immune rejection, but may lead to donor area damage and prolong the surgical time for tissue collection. Allogeneic tissue grafts include acellular dermal matrix, lyophilized rib cartilage, and extracellular matrix collagen, and decellularized nipple tissue. Allogeneic tissue grafts do not cause additional donor area damage, are highly malleable, and can be designed to be utilized according to the recipient area, but the high cost often limits the development of this technique. CONCLUSION There is no gold standard regarding tissue graft-assisted nipple projection reconstruction techniques, and there are advantages and disadvantages to both autologous and allogeneic tissue grafts. Surgeons should choose the appropriate graft based on the actual condition of the patient.
Humans ; Adipose Tissue ; Autografts ; Costal Cartilage ; Nipples/surgery* ; Transplants

Necrosis of nipple-areola complex is one of the major complications of breast reduction in gigatomastia. We present a case study of a 32-year-old patient with severe gigantomastia, who required an immediate nipple reconstruction during breast reduction. The final reconstruction was satisfactory. No complications were observed within three months postoperatively.
Adult ; Breast/surgery* ; Female ; Humans ; Hypertrophy/surgery* ; Mammaplasty/methods* ; Nipples/surgery* ; Surgical Flaps ; Treatment Outcome

OBJECTIVETo explore an ideal technique for remodeling the breast after resection of large breast fibroadenoma.

METHODSBased on the principle of breast reduction, an operation plan was designed. The new locations of the nipple, and the areola and the area of the breast skin to be resected were marked. The preoperative-marked skin, epidermis, and the whole breast tumor were resected routinely. Then breast remodeling followed according to augmentation mammoplasty. Seven patients underwent this operation.

RESULTSThe operative results were satisfactory in terms of multiple parameters during the follow-up period.

CONCLUSIONSThis operation can effectively resect the breast tumor and remodel the breast simultaneously.

Breast ; abnormalities ; surgery ; Breast Neoplasms ; pathology ; surgery ; Female ; Fibroadenoma ; pathology ; surgery ; Humans ; Hypertrophy ; surgery ; Mammaplasty ; methods ; Nipples ; surgery

Breast Diseases ; surgery ; Child ; Female ; Humans ; Nipples ; abnormalities ; surgery ; Reconstructive Surgical Procedures ; methods

Adult ; Breast Neoplasms ; diagnosis ; metabolism ; surgery ; Female ; Humans ; Nipples ; pathology ; surgery ; Ultrasonography ; methods

OBJECTIVEA new method for correction of nipple inversion was introduced to improve the surgical result.

METHODSIn this procedure, two opposite rhombus incisions on both sides of the inverted nipple were designed within the range of areola. The rhombus skin was deepithelialized and two subcutaneous pedicle skin flaps were created. Then the shortened lactiferous ducts and fibrous bands beneath the nipple were released. The subcutaneous pedicle skin flaps on both sides of the inverted nipple were advanced through the tunnel beneath the nipple as the supporting tissue. After the operation, continuous traction of the nipple lasted two weeks at least.

RESULTSSince 1999, 16 patients with congenital bilateral nipple inversion have been treated. No complications were found in all the cases. Postoperative follow-up for 2-12 months showed that the appearance of the nipple was satisfactory.

CONCLUSIONSThis method is simple, safe and effective for correction of congenital nipple inversion. The incision scar is indistinct, the natural look and good function of the nipple were reserved.

Adolescent ; Adult ; Female ; Humans ; Nipples ; abnormalities ; surgery ; Surgery, Plastic ; methods ; Surgical Flaps ; Treatment Outcome

BACKGROUND: Mastectomy techniques have been extended to nipple-sparing mastectomy (NSM). This study aimed to assess the actual application of NSM in China and identify the factors influencing postoperative complications. METHODS: The clinical data of 615 patients (641 surgeries) undergoing NSM from January 1st, 2018 to December 31st, 2018 at 28 centers nationwide were retrospectively analyzed to obtain the rate of NSM and investigate factors related to NSM surgery. RESULTS: The proportion of NSM surgery performed in this study was 2.67% (17/641). Malignant breast tumors accounted for the majority of NSM surgery (559/641, 87.2%). A total of 475 (77.3%) patients underwent NSM combined with reconstructive surgery. The rate of reconstruction decreased with age in our study, and implants were the most common option (344/641, 53.7%) in reconstruction. Radial incision was the most selected method regardless of reconstruction. However, for those who underwent reconstruction surgery, 18.4% (85/462) of cases also chose curvilinear incision, while in the simple NSM surgery group, more patients chose circumareolar incision (26/136, 19.1%). The tumor-to-nipple distance (TND) influenced postoperative complications (P = 0.004). There were no relationships between postoperative complications and tumor size, tumor location, histologic grade, molecular subtype, nipple discharge, and axillary lymph nodes. CONCLUSIONS: NSM surgery is feasible and only TND influenced postoperative complications of NSM surgery. But the proportion of NSM surgery performed is still low in nationwide centers of China. The selection criteria for appropriate surgical methods are important for NSM in clinical practice. To optimize clinical applications of NSM, further multicenter prospective randomized controlled studies are needed. TRIAL REGISTRATION ChiCTR.org.cn, ChiCTR1900027423; http://www.chictr.org.cn/showprojen.aspx?proj=38739.
Breast Neoplasms/surgery* ; China ; Humans ; Mammaplasty ; Mastectomy ; Nipples/surgery* ; Prospective Studies ; Retrospective Studies

Objective: To explore the surgical strategy of nipple areola complex (NAC) management in central breast cancer. Methods: A retrospective analysis was conducted on 164 cases of central breast cancer who underwent surgery treatment from December 2017 to December 2020 in the Breast Center of Beijing Tongren Hospital, Capital Medical University. Prior to the surgery, the tumor-nipple distance (TND) and the maximum diameter of the tumor were measured by magnetic resonance imaging (MRI). The presence of nipple invagination, nipple discharge, and nipple ulceration (including nipple Paget's disease) were recorded accordingly. NAC was preserved in patients with TND≥0.5 cm, no signs of NAC invasion (nipple invagination, nipple ulceration) and negative intraoperative frozen pathological margin. All patients with signs of NAC involvement, TND<0.5 cm or positive NAC basal resection margin confirmed by intraoperative frozen pathology underwent NAC removal. χ(2) test or Fisher exact test was used to analyze the influencing factors. Results: Of the 164 cases of central breast cancer, 73 cases underwent breast-conserving surgery, 43 cases underwent nipple-areola complex sparing mastectomy (NSM), 34 cases underwent total mastectomy, and the remaining 14 cases underwent skin sparing mastectomy (SSM). Among the 58 cases of NAC resection (including 34 cases of total mastectomy, 14 cases of SSM, and 10 cases of breast-conserving surgery), 25 cases were confirmed tumor involving NAC (total mastectomy in 12 cases, SSM in 9 cases, and breast-conserving surgery in 4 cases). The related factors of NAC involvement included TND (P=0.040) and nipple invagination (P=0.031). There were no correlations between tumor size (P=0.519), lymph node metastasis (P=0.847), bloody nipple discharge (P=0.742) and NAC involvement. During the follow-up period of 12 to 48 months, there was 1 case of local recurrence and 3 cases of distant metastasis. Conclusions: For central breast cancer, data suggest that patients with TND≥0.5cm, no signs of NAC invasion (nipple invagination, nipple ulceration) and negative NAC margin in intraoperative frozen pathology should be treated with NAC preservation surgery, whereas for those with TND<0.5 cm or accompanied by signs of NAC invasion, NAC should be removed. In addition, nipple reconstruction can be selected to further improve the postoperative appearance of patients with central breast cancer.
Breast Neoplasms/surgery* ; Female ; Humans ; Mammaplasty/methods* ; Mastectomy/methods* ; Nipples/surgery* ; Retrospective Studies