Tocco-Tussardi Ilaria, Mobargha Nathalie, Bassetto Franco, Vindigni Vincenzo
Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, 751 85 Uppsala, Sweden; Clinic of Plastic and Reconstructive Surgery, Department of Neurosciences, University of Padova, Via Giustiniani 2, 35128 Padova, Italy.
Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, 751 85 Uppsala, Sweden.
Int J Surg Case Rep. 2016;28:117-120. doi: 10.1016/j.ijscr.2016.09.027. Epub 2016 Sep 22.
Nevoid hyperkeratosis of the nipple and/or areola (NHNA) is a benign lesion with a female predominance and an aesthetically disturbing appearance. Spontaneous remission is not reported and medical treatments proposed so far have shown variable results.
We describe a rare case of an extensive variant of NHNA covering almost the entire breasts' surface. At present, only three other reports are present in the literature. Medical treatment proved not completely effective and the patient was also affected by a significant breast asymmetry-hypertrophy. Therefore, NHNA was managed surgically with excision of the areolar affected portions while performing breast reduction-lift. The result was satisfactory and without recurrence of lesions at 5-year follow-up.
This case reported favorable outcomes of surgery for NHNA. Reports of success with these procedures are still limited, but the promising results in terms of radicality and aesthetic outcome suggest it should be offered to patients as a viable therapeutic option.
Indications for surgical treatment of NHNA can be: unsatisfying response to topical agents; young patients who want to restore the aesthetic appearance of the breast; and patients with concomitant indication for corrective surgery of the breast. Advantages are: predictable time of healing; predictable final result; radical excision of the affected tissue; and possibility of histologic analysis of the whole areola. In rare cases of lesions extending to the breast, preliminary treatment with topical agents can limit the extent of excision. Management and treatment should always be tailor-made for each individual case.
乳头和/或乳晕痣样角化过度症（NHNA）是一种良性病变，女性多见，外观影响美观。未见自发缓解的报道，目前提出的药物治疗效果不一。
我们描述了1例罕见的广泛型NHNA病例，几乎累及整个乳房表面。目前，文献中仅有另外3篇报道。药物治疗证明不完全有效，且患者还存在明显的乳房不对称性肥大。因此，对NHNA进行了手术治疗，切除乳晕受累部分，同时进行乳房缩小上提术。结果令人满意，5年随访未见病变复发。
该病例报告了NHNA手术治疗的良好效果。这些手术成功的报道仍然有限，但在根治性和美学效果方面的 promising results 表明，应将其作为一种可行的治疗选择提供给患者。
NHNA手术治疗的指征可以是：对局部用药反应不满意；希望恢复乳房美观外观的年轻患者；以及有乳房矫正手术伴随指征的患者。优点包括：愈合时间可预测；最终结果可预测；受累组织根治性切除；以及对整个乳晕进行组织学分析的可能性。在罕见的病变累及乳房的情况下，局部用药的初步治疗可限制切除范围。管理和治疗应始终根据每个病例量身定制。
