ADMISSIONS OPEN for MCh Breast Oncoplasty 2019 Batch

Nipple-Areola Complex Sparing Mastectomy

    General Details:

    39 year old married female

    Symptoms/ Signs:

    Lump in Upper Inner Quadrant of Left Breast since 6 months

    Swelling in Left hands since 6 months

    Examination:

    Definite single and palpable hard mass 2-5cms in size

    No skin or nipple changes

    No axillary lymph nodes

    History:

    No significant medical or gynaecologic history

    Menstrual H/o – Normal

    Family h/o bladder cancer in grandmother

    Diagnostics:

  • On Digital Mammography with 3D tomosynthesis:
    Cluster of branching microcalcifications seen in lower inner quadrant of left breast.
    Findings s/o high grade DCIS with comedo necrosis. BIRADS IV lesion.
  • On Sonomammography:
    24x16mm hypoechoic lesion with multiple tiny calcifications at 9’o clock position
  • FNAC showed Malignant Breast Lesion

    Management:

    Left Nipple-areola complex sparing mastectomy with subpectoral implant with Left sentinel node biopsy with Right Breast Mastopexy

    Discussion:

    Nipple-Areola Complex (NAC) is at 26 cm from suprasternal notch on the Left Breast is and 24 cms

    on the right side.

    Tumour is at 9 o’clock position extending to 10 o’clock

    Wise pattern marking is done

    NAC is taken on superior pedicel

    Inferior pedicle is converted into a sling

    Mastectomy is commenced

    Lower dermal sling is prepared from the lower segment

    Flaps are raised medially and laterally and breast is removed

    Breast after removal shows the patch of NAC

    The nipple is cored out and NAC is dissected off

    Mastectomy is completed and flaps are examined for uniformity

    Flaps are dissected in the correct plane

    Pectoralis muscle is raised, and the sling and Pectoralis Major are sutured together with Vicryl

    The port is inserted and NAC is sutured back


    Surgery conducted on the opposite breast:-

    Opposite breast is reduced with a vertical scar technique using the superior pedicle carrying the

    nipple-areola complex and the inferior pedicle is used for auto-augmentation

    Inferior pedicle is fixed to the chest wall

    The lateral and medial pillars are closed in the midline

    T cut is given to remove the excess skin and to give a round shape

    Surgical Histopathology Report:

    Total excised mass: 500gm – 18cm x 18cm x 3cm

    Original tumour size – 2cm x 2cm x 1.5cm

    Margins: Free

    Nodal involvement: 2 sentinel nodes negative for atypical or malignant cells

    Tumour showed DCIS with central necrosis

    On tissue blocks:-

    ER/ PR - positive

    HER 2 – negative

    Adjuvant Hormonal Therapy:

    Tab. Tamoxifen 20 mg once a day for 5 years

Videos