mastectomy followed by autologous reconstruction in patients with large, ptotic breasts often offers a limited field, resulting in strenuous traction. Skin-sparing mastectomy (SSM) with immediate nipple grafting from the specimen was attempted for such patients. Patients who underwent SSM with immediate autologous breast reconstruction and nipple grafting between September 2016 and February 2019 were evaluated, including 33 nipple grafts in 30 patients. The average weight of the mastectomy specimen was 552.5 g and the average operation time for unilateral mastectomy was 109 minutes. No complete nipple loss or major skin flap necrosis was reported. Adjuvant therapy started after an average of 24 days. SSM with immediate nipple grafting on the autologously reconstructed breast could be an alternative for large, ptotic breasts. It is also useful for patients requiring contralateral balancing procedures or those with bilateral breast cancer in which only one nipple can be spared oncologically.]]>
Breast Neoplasms ; Breast ; Female ; Free Tissue Flaps ; Humans ; Mammaplasty ; Mastectomy ; Mastectomy, Subcutaneous ; Necrosis ; Nipples ; Skin ; Traction ; Transplants

mastectomy (NSM) are expanding, there remains a debate regarding the oncologic outcomes of patients treated with this method, especially those with a short tumor–nipple distance (STND). The aim of this study was to compare the long-term oncologic outcomes between patients with a long tumor–nipple distance (LTND) (≥ 2.0 cm) and those with STND (< 2.0 cm).METHODS: This was a retrospective study in which 266 patients who underwent NSM with immediate breast reconstruction between January 2008 and December 2014 at a single institution were enrolled. Of these patients, 21 were excluded because of loss to follow-up; thus, 245 patients were finally analyzed. All patients underwent preoperative breast magnetic resonance imaging and intraoperative frozen biopsy.RESULTS: The mean age of the patients was 42.4 years. STND was identified in 128 patients, and LTND in 117 patients. The mean follow-up period was 60.5 months. There were no significant differences between the 2 groups with respect to lymphovascular invasion, nuclear grade, nodal status, and subtype (p = 0.339, 0.372, 0.955, and 0.338, respectively). The STND group had significantly smaller tumors than the LTND group (p = 0.005). The median TND in the STND and LTND groups was 0.7 cm and 3.0 cm, respectively. Locoregional recurrence was reported in 4 patients in the STND group (3.1%) and 6 (5.1%) in the LTND group. A total of 3 patients died (1.2%; 2 in the STND group and one in the LTND group). There was no significant difference between the 2 groups with respect to disease-free survival or local recurrence-free survival (p = 0.334 and p = 0.477, respectively).CONCLUSION: The long-term oncologic outcomes of patients treated with NSM did not significantly differ according to TND when the intraoperative frozen biopsy was negative for tumor cells.]]>
Biopsy ; Breast Neoplasms ; Breast ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Mammaplasty ; Mastectomy ; Mastectomy, Subcutaneous ; Methods ; Prognosis ; Recurrence ; Retrospective Studies

Gigantomastia is an abnormal proliferation of breasts by excessive mammary tissue. Pseudoangiomatous stromal hyperplasia (PASH) is a rare benign disease due to nonspecialized fibrous mammary stroma. The incidence of gigantomastia caused by bilateral diffuse PASH is extremely rare. The authors experienced a unique case of recurrent PASH-caused gigantomastia after reduction mammoplasty. Recurrent PASH-caused gigantomastia has never been reported in the literature so far. A 33-year-old woman who suffered of gigantomastia underwent bilateral reduction mammoplasty 4 years ago. Recurrence occurred, and she visited our department. Both breasts were dense without palpable mass. Mammography revealed extremely dense breasts with a bilateral complex glandular pattern. Mastectomy with Wise-pattern incision line was performed. Nipple was reconstructed at the same time using the triangular skin flaps. Pathologic examination revealed numerous slit-like stromal clefts lined by endothelial-like spindle cells were present in well demarcated nodules and diffuse hyperplastic stromas. The finding was consistent with PASH. Reconstruction of aesthetic breast was impossible due to thinned remaining skin and subcutaneous fat tissues. Nevertheless, patient was satisfied, for her anxiety about relapse and discomfort was gone.
Adult ; Anxiety ; Breast ; Female ; Humans ; Hyperplasia* ; Incidence ; Mammaplasty* ; Mammography ; Mastectomy ; Nipples ; Recurrence ; Skin ; Subcutaneous Fat

Various reconstructive and/or oncoplastic options are available for breast cancer patients. In properly selected patients, autologous tissue-based reconstruction usually results in aesthetic, natural breasts. The choice of a reconstructive option for a breast cancer patient is a multifactorial decision that should consider the patient's values and preferences, as well as oncologic variables. A case of a 47-year-old woman who underwent bilateral skin-sparing mastectomy (SSM) and bilateral abdominally-based reconstruction despite having unilateral breast cancer. Right SSM and left lumpectomy were indicated for ductal carcinoma in situ in the right breast and benign tumors with microcalcifications in the left breast. The patient had very small breasts and wished for larger breasts, using her own tissue, to be created in a single-stage operation. Right SSM and left subcutaneous mastectomy were followed by bilateral free transverse rectus abdominis flap reconstruction and nipple sharing.
Breast Neoplasms ; Breast ; Carcinoma, Intraductal, Noninfiltrating ; Female ; Humans ; Mammaplasty ; Mastectomy ; Mastectomy, Segmental ; Mastectomy, Subcutaneous ; Middle Aged ; Nipples ; Rectus Abdominis ; Unilateral Breast Neoplasms

Preservation of the breast skin envelope during immediate implant-based breast reconstruction is important for producing symmetrical and natural-looking breasts. We propose the lazy S design for the closure of round-shaped wounds with the hope of improving the aesthetic outcomes and reducing the tension on the wound by preserving the skin. Additionally, the direction of tension is dispersed due to the shape of this design. Patients undergoing implant reconstruction after skin-sparing mastectomy may benefit from the lazy S design.
Breast Implants ; Breast* ; Female ; Hope ; Humans ; Mammaplasty* ; Mastectomy* ; Mastectomy, Subcutaneous ; Reconstructive Surgical Procedures ; Skin* ; Wounds and Injuries

Women with BRCA1/2 mutations have a high risk of breast cancer and may opt for risk-reducing mastectomy (RRM). We report a 38-year-old Japanese woman who was diagnosed as a BRCA2 mutation carrier. She underwent prophylactic bilateral skin-sparing mastectomy (SSM) with excision of the nipple and preservation of the areola skin. It is unclear whether a bilateral RRM leads to better survival compared with intensive surveillance. The oncological risk associated with the presence of remnant breast glandular tissue after SSM or nipple-sparing mastectomy has been obscure. We report the first case of RRM for a Japanese BRCA mutation carrier and provide a literature review on risk management for BRCA mutation carriers with a focus on the concepts and procedures of RRM.
Adult ; Asian Continental Ancestry Group ; Breast ; Breast Neoplasms ; Female ; Humans ; Mastectomy* ; Mastectomy, Subcutaneous ; Nipples ; Prophylactic Surgical Procedures ; Risk Management ; Skin

BACKGROUND: One of the most common breast reconstruction techniques that uses autologous tissue is the free muscle-sparing transverse rectus abdominis myocutaneous (MS-TRAM) flap. However, patients hesitate to choose this method because of the long transverse scar between the anterior superior iliac spines. Furthermore, traditional reconstruction using a free MS-TRAM flap entails donor site morbidities such as pain, hematoma, or seroma. Here, we introduce a mini-abdominoplasty-designed free TRAM flap with flap beveling, which can be a good method for breast reconstruction in Asian patients who have small breasts. METHODS: Breast reconstruction with free MS-TRAM flaps using the mini-abdominoplasty design and flap beveling was performed in 10 patients following mastectomy. Patient age, presurgical brassiere cup size, tumor type, operation type, excised breast weight, elevated flap weight, flap weight used for the breast, recipient vessel, operation time, day that the abdominal drain was removed, and complications associated with both the flap and donor site were documented for all flaps and patients. RESULTS: For all 10 mini-abdominoplasty-designed free TRAM flap procedures, no flap loss or donor site morbidity was noted over a mean follow-up time of 16 months. CONCLUSIONS: The mini-abdominoplasty-designed free TRAM flap can safely and satisfactorily be implanted for the reconstruction of mastectomy defects. It can transfer the lower abdominal skin and subcutaneous tissue for breast reconstruction with minimal donor site scarring and morbidity, especially in Asian patients, who generally have smaller breasts.
Abdominoplasty ; Asian Continental Ancestry Group ; Breast* ; Cicatrix ; Female ; Follow-Up Studies ; Free Tissue Flaps* ; Hematoma ; Humans ; Mammaplasty* ; Mastectomy ; Myocutaneous Flap ; Rectus Abdominis ; Seroma ; Skin ; Spine ; Subcutaneous Tissue ; Tissue Donors

Pseudoangiomatous stromal hyperplasia (PASH) of the breast is a benign mesenchymal lesion with incidental histologic findings. Surgical excision is recommended as the treatment of choice for PASH, although the recurrence rates after excision range from 15% to 22%. A 46-year-old-female presented with a six-month history of bilateral breast enlargement and painful sensation mimicking inflammatory carcinoma. Imaging studies demonstrated innumerable enhancing nodules in both breasts. Due to the growth of the lesions and progressive clinical symptoms, bilateral subcutaneous mastectomy was performed. Grossly, the specimens were round and well-circumscribed, and the histologic examination revealed PASH. After mastectomy, we created a pocket with the pectoralis major muscle and a lower skin flap, which was deepithelized. Anatomical mammary implants were inserted, and the nipple areolar complex was transferred to a new position as a free graft. The aesthetic result was satisfactory after twelve months of follow-up.
Breast* ; Female ; Follow-Up Studies ; Hyperplasia* ; Mammaplasty ; Mastectomy ; Mastectomy, Subcutaneous ; Nipples ; Recurrence ; Sensation ; Skin ; Transplants

This procedure was developed for preservation of the rectus muscle components and deep inferior epigastric vessel after deep inferior epigastric perforator (DIEP) flap harvesting. A 53-year-old woman with granuloma caused by silicone injection underwent bilateral nipple-sparing mastectomies and immediate reconstruction with "mini-flow-through" DIEP flaps. The flaps were dissected based on the single largest perforator with a short segment of the lateral branch of the deep inferior epigastric vessel that was transected as a free flap for breast reconstruction. The short segments of the donor deep inferior epigastric vessel branch are primarily end-to-end anastomosed to each other. A short T-shaped pedicle mini-flow-through DIEP flap is interposed in the incised recipient's internal mammary vessels with two arterial and four concomitant venous anastomoses. Although it requires multiple vascular anastomoses and a short pedicle for the flap setting, the mini-flow-through DIEP flap provides a large pedicle caliber, enabling safer microsurgical anastomosis and well-vascularized tissue for creating a natural breast without consuming time or compromising the rectus muscle components and vascular flow of both the deep inferior epigastric and internal mammary vessels.
Breast* ; Female ; Free Tissue Flaps ; Granuloma ; Humans ; Mammaplasty* ; Mastectomy ; Mastectomy, Subcutaneous ; Microsurgery ; Middle Aged ; Perforator Flap* ; Silicon ; Silicones ; Tissue Donors

BACKGROUND: In the literature on nipple-sparing mastectomy (NSM) with one-stage immediate implant reconstruction, contralateral symmetrisation has drawn little attention, with many surgeons still performing standard cosmetic mammaplasty procedures. However, standard implant-based mammaplasty usually does not result in proper symmetry with the mastectomy side, especially regarding breast projection, overall shape, and volume distribution. METHODS: We retrospectively reviewed 19 consecutive patients undergoing unilateral NSM with immediate prosthetic reconstruction and contralateral simultaneous symmetrisation by using the tailored reduction/augmentation mammaplasty technique between June 2012 and August 2013. RESULTS: The average follow-up time was 13 months (range, 10-24 months). No major complications, such as infection, haematoma, and nipple-areola complex necrosis, were experienced. CONCLUSIONS: Our experience suggests that simultaneous contralateral symmetrisation with tailored reduction/augmentation mammaplasty after unilateral immediate implant reconstruction after NSM facilitates durable and pleasant symmetric outcomes.
Breast Implants ; Breast* ; Female ; Follow-Up Studies ; Humans ; Mammaplasty* ; Mastectomy* ; Mastectomy, Subcutaneous ; Necrosis ; Retrospective Studies