Objective: To examine the outcome of different incision selection for nipple-sparing mastectomy (NSM) with implant-based breast reconstruction (IBBR). Methods: Ninety-Two cases accepted NSM and IBBR from totally 1 002 cases of breast cancer admitted to Beijing Tongren Hospital Affiliated to Capital Medical University from June 2013 to December 2020 were analyzed retrospectively. All the patients were female, aging (42.0±7.5) years (range: 27 to 64 years). There were 12 patients at stage 0, 47 patients at stage Ⅰ, 17 patients at stage Ⅱ, and 16 patients at stage Ⅲ. The patients were divided in three groups by the incision: peri-areolar group (n=23), inframammary group (n=33) and lateral group (n=36). The age, tumor size, lymph node status, hormone receptor, operation method and postoperative complications were followed-up of three groups and compared by one-way ANOVA, χ² test or Fisher's exact test and expansion to comparied. Results: There was no significant difference in operation time ((180.7±54.0) minutes vs. (176.9±48.1) minutes vs. (194.6±37.5) minutes, F=1.401, P=0.252), postoperative drainage volume ((497.5±226.0) ml vs. (495.4±182.5) ml vs. (519.8±172.0) ml, F=0.167, P=0.846) and drainage time ((8.8±3.8) days vs. (8.0±2.5) days vs. (8.3±2.9) days, F=0.542, P=0.583) among the peri-areolar, inframammary, and lateral groups. The cumulative postoperative complications were relatively higher in the peri-areola group (26.1%(6/23) vs. 0 vs.8.3%(3/36), χ²=9.675, P=0.004). All female patients were followed up for (49.0±25.6) months(range: 12 to 112 months). Breast cancer related death rate was 2.2% (2/92), local recurrence was 1.1% (1/92), regional recurrence was 4.3% (4/92), distant metastasis was 6.5% (6/92), and the disease-free survival rate was 88.0% (81/92). Conclusion: The surgical effects of the peri-areolar, inframammary and lateral incisions for NSM and IBBR are approximate, the total complication rate of the peri-areolar incision is slightly higher.
Breast Neoplasms/pathology* ; Female ; Humans ; Mammaplasty/methods* ; Mastectomy/methods* ; Nipples/surgery* ; Retrospective Studies

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

OBJECTIVETo investigate the trans-areola approach for costicartilage harvesting in order to avoid the obvious scar resulted by traditional approach through chest incision.

METHODSFrom 2013, 7 cases who underwent rhinoplasty received costicartilage harvesting through trans-areola approach. The incision was designed along the lower interior edge of right areola. Then the dissection was performed to expose the 5th costicartilage. Then a costicartilage, 2 - 5 cm in length, was harvested. The incision was closed delicately. The suture was removed 7 days after operation.

RESULTSThe patients were followed up for 3 months to 2 years without hypertrophic scar and breast deformity. The scar was located in conceal location. The satisfactory rate was higher than that in patients with chest incision.

CONCLUSIONSThe scar resulted from trans-areola approach is comparatively conceal, compared with that at chest.

Breast ; surgery ; Cicatrix ; pathology ; Costal Cartilage ; Dissection ; methods ; Female ; Follow-Up Studies ; Humans ; Nipples ; surgery ; Rhinoplasty ; methods ; Time Factors ; Tissue and Organ Harvesting ; methods ; Transplant Donor Site

OBJECTIVETo investigate the application of combining mastopexy and triple-plane breast augmentation in correction of breast ptosis and atrophy.

METHODSPeri-areolar incision was performed to finish the fascia and dermal suspension to correct the breast ptosis. The implant was inserted under the pectoralis major muscle through lateral lower border of the gland and a "X" shape full thickness incision was made on the pectoralis major muscle according to the new position of nipple-areolar complex.

RESULTS14 patients received combined mastopexy and triple-plane breast augmentation to correct breast atrophy and mastopexy simultaneously. All the patients were regularly followed for 6-12 months. No patients suffered severe complication and the results were satisfied.

CONCLUSIONS"Triple-plane" breast augmentation could be safely performed with peri-areolar mastopexy with minor injury. The technique could help to ensure the balance between the gland, nipple-areolar complex and the implant.

Atrophy ; surgery ; Breast ; pathology ; surgery ; Breast Implantation ; methods ; Female ; Humans ; Mammaplasty ; methods ; Nipples ; pathology ; surgery ; Pectoralis Muscles ; surgery

OBJECTIVETo explore an ideal surgical method for nipple hypertrophy correction.

METHODSFrom July 2008 to June 2011, 44 nipple reductions were performed for 22 women (44 sides) by using the modified Z-shaped incision technique. The incision consists of two circles, one quadrangle and one triangle located on the top, body and base of the nipple. The nipple's height was decreased and the nipple diameter and base area were reduced. Bilateral nipples were designed symmetrically.

RESULTS22 cases(44 sides) were treated with primary healing. The mean diameter of the nipple was reduced to (9.8 +/- 1.6) mm from (17.6 +/- 3.4) mm, the average height from (18.8 +/- 3.6) mm to (8.2 +/- 1.4) mm, with the patient supine. All the patients were followed up for 14 months to 4 years with satisfactory results. No nipple necrosis, infection and numb happened. 20 patients completed the self-designed survey scale 1 year after operation, of which 4 cases achieved normal lactation, and the remaining patients didn't have childbirth and breastfeeding yet.

CONCLUSIONSThe modified Z-shaped incision technique could reduce the height, diameter, and most importantly, reduce the basal shape of all types of hypertrophic nipple to create a desired new cylindrical nipple without affection of nipple sensation and function.

Adolescent ; Adult ; Female ; Humans ; Hypertrophy ; Mammaplasty ; methods ; Nipples ; pathology ; surgery ; Treatment Outcome ; Young Adult

Abscess ; pathology ; Adenoma ; metabolism ; pathology ; Adenoma, Sweat Gland ; metabolism ; pathology ; Biomarkers ; metabolism ; Breast Diseases ; pathology ; Breast Neoplasms ; metabolism ; pathology ; Female ; Fistula ; pathology ; Humans ; Keratin-7 ; metabolism ; Keratins ; metabolism ; Mucin-1 ; metabolism ; Nipples ; pathology ; Paget's Disease, Mammary ; metabolism ; pathology ; Receptor, ErbB-2 ; metabolism ; Sweat Gland Neoplasms ; metabolism ; pathology

OBJECTIVETo investigate the pathologic and immunohistochemical features, diagnosis and differential diagnosis of low-grade adenosquamous carcinoma of the breast and syringomatous adenoma of the nipple.

METHODSSix cases of low-grade adenosquamous carcinoma of the breast and four cases of syringomatous adenoma of the nipple were examined histologically and immunohistochemically (MaxVision method), and the literature was reviewed.

RESULTSThe two types of tumors were similar in morphology, but located in different regions with low-grade adenosquamous carcinoma being present in the deep parenchyma and syringomatous adenoma in nipple. Both types of tumors were composed mainly of well-differentiated glands with angulated, comma shaped or polliwog appearance in a disordered infiltrative pattern. The tumor cells also formed solid tubules, strips or nests, with frequent areas of squamoid differentiation. Mitosis was rare. The interstitial tissue showed abundant spindle cells or sclerotic fibrosis with mixed inflammatory cells infiltration. One case of low-grade adenosquamous carcinoma showed a concomitant malignant adenomyoepithelioma, and another case showed concomitant spindle cell metaplastic carcinoma. One case of syringomatous adenoma involved the deep parenchyma. Immunohistochemistry of low-grade adenosquamous carcinoma showed that CK5/6 and p63 were positive in the outer layer of the glands and the squamoid epithelium, and CD10 was also positive in the outer layer of the glands. ER and HER2 were negative, and PR was also negative except for one case in which the spindle cells were positive for CK5/6, AE1/AE3 and PR focally. Immunostaining of syringomatous adenoma demonstrated that p63 and CK5/6 were positive in the outer layer of the glands and the squamoid epithelium. Calponin, SMA, ER, PR and HER2 were all negative.

CONCLUSIONSLow-grade adenosquamous carcinoma of the breast and syringomatous adenoma of the nipple are similar in morphology and immunohistochemical phenotype, while the biological features are opposite due to different locations. The differential diagnoses include tubular carcinoma, adenosquamous carcinoma, radial sclerosing lesions and others.

Adenocarcinoma ; pathology ; Adult ; Aged ; Breast ; pathology ; Breast Neoplasms ; diagnosis ; metabolism ; pathology ; Carcinoma, Adenosquamous ; diagnosis ; metabolism ; pathology ; Carcinoma, Squamous Cell ; pathology ; Diagnosis, Differential ; Female ; Humans ; Immunohistochemistry ; Keratin-5 ; metabolism ; Keratin-6 ; metabolism ; Middle Aged ; Neprilysin ; metabolism ; Nipples ; pathology ; Sclerosis ; Sweat Gland Neoplasms ; diagnosis ; metabolism ; pathology ; Syringoma ; diagnosis ; metabolism ; pathology ; Transcription Factors ; metabolism ; Tumor Suppressor Proteins ; metabolism

OBJECTIVETo investigate the clinicopathological and immunohistochemical features, diagnosis and differential diagnosis of nipple adenoma of the breast.

METHODSMorphological observation and immunohistochemistry were applied to 18 cases of nipple adenoma with a review of the related literatures.

RESULTSThe neoplasms were localized at nipples or under the areola of breast, adherent to the epidermis, mainly composed of dilated ducts in a tubular appearance associated with fibrotic matrix. The glandular epithelium showed various type of proliferation, forming thick layers or complex structures such as papillae, micropapillae, tufts, fronds, arcades or bridges accompanying with solid or cribriform cell nests. The tumor cells were crowding, lack of an uniform morphology and polarity with intact myoepithelial cells around the ducts. By immunostaining, the glandular epithelium was diffusely positive for 34betaE12, patchily positive for CK5/6, and negative for p53 and c-erbB-2. The myoepithelium, positive for p63, smooth muscle actin and Calponin, was well preserved and outlining the ducts.

CONCLUSIONSNipple adenoma is an infrequent type of benign breast neoplasm, presenting as sclerosing papilloma, papillomatosis or florid sclerosing adenosis. It is easily confused with atypical ductal hyperplasia/low grade ductal carcinoma in situ, invasive ductal carcinoma or low grade adenosquamous carcinoma. A correct diagnosis is based on the peculiar location and morphology of the tumor, and immunohistochemistry is helpful in some cases.

Adenoma ; metabolism ; pathology ; surgery ; Adult ; Breast Neoplasms ; metabolism ; pathology ; surgery ; Carcinoma in Situ ; metabolism ; pathology ; Carcinoma, Adenosquamous ; metabolism ; pathology ; Carcinoma, Ductal, Breast ; metabolism ; pathology ; Diagnosis, Differential ; Female ; Humans ; Keratin-5 ; metabolism ; Keratins ; metabolism ; Middle Aged ; Nipples ; metabolism ; pathology ; surgery

OBJECTIVE: To evaluate whether the removal of an intraductal mass using an ultrasound (US)-guided directional vacuum-assisted device can eliminate symptoms in patients presenting with abnormal nipple discharge. MATERIALS AND METHODS: Between March 2004 and October 2006, 36 patients who presented with abnormal nipple discharge, underwent US-guided, 11-gauge vacuum-assisted biopsy for a benign intraductal single mass on US. The ability of the procedure to eliminate nipple discharge was evaluated by physical examination during follow-up US. Lesion characteristics, biopsy variables, and histologic features were analyzed to identify factors affecting symptom resolution. RESULTS: Of the 36 lesions, 25 (69%) were intraductal papillomas, 10 (28%) were fibrocystic changes, and one (3%) was a fibroadenoma. The nipple discharge disappeared in 69% (25 of 36) of the women at a mean follow-up time of 25 months (range 12-42 month). There was no difference in the lesion characteristics, biopsy variables, and the histologic features between groups that eliminated the symptom compared those with persistent nipple discharge. CONCLUSION: US-guided directional vacuum-assisted removal of an intraductal mass appears to eliminate nipple discharge in only 69% of patients and thus, it should not be considered as an alternative to surgical excision.
Adult ; Biopsy/*methods ; Breast Neoplasms/pathology/*ultrasonography ; Chi-Square Distribution ; Exudates and Transudates/*ultrasonography ; Female ; Humans ; Mammography ; Middle Aged ; Nipples/pathology/*ultrasonography ; Papilloma, Intraductal/pathology/*ultrasonography ; Retrospective Studies ; *Ultrasonography, Interventional ; *Ultrasonography, Mammary ; Vacuum

OBJECTIVE: To assess the value of fiberoptic ductoscopy (FDS) in the diagnosis of nipple discharge. METHODS: Clinical records of 1,025 patients with nipple discharge undergoing FDS from February 2006 to March 2008 were reviewed. RESULTS: There were obviously differences in the FDS diagnosis of various nipple discharge traits. The diagnosis by FDS was pathologically confirmed in 93.7%of patients with nipple discharge (404/431). CONCLUSION FDS can effectively improve the diagnosis of nipple discharge,and has great clinical significance.
Adolescent ; Adult ; Aged ; Breast Diseases ; diagnosis ; pathology ; Breast Neoplasms ; diagnosis ; metabolism ; pathology ; Child ; Endoscopy ; methods ; Female ; Fiber Optic Technology ; methods ; Humans ; Male ; Middle Aged ; Nipples ; metabolism ; Papilloma, Intraductal ; diagnosis ; metabolism ; pathology ; Retrospective Studies ; Sensitivity and Specificity ; Young Adult