Matsuki Hitomi, Oura Shoji
Department of Surgery, Kishiwada Tokushukai Hospital, Kishiwada, Japan.
Case Rep Oncol. 2024 Sep 13;17(1):1014-1018. doi: 10.1159/000540892. eCollection 2024 Jan-Dec.
Nipple retraction has long been regarded as an absolute contraindication factor for nipple preservation in breast cancer surgery.
A 62-year-old woman was referred to our hospital for the treatment of breast cancer with slight nipple retraction. Imaging findings showed neither direct cancer infiltration to the nipple-areolar complex nor lymphadenopathy. Due to the patient's strong preference, we attempted to preserve the nipple-areolar complex as follows. First, we made a quasi-complete skin flap except for the nipple-areolar complex area in a thick flap manner. Second, we fully skeletonized the sub-nipple mammary gland. Next, we pinched the skeletonized sub-nipple mammary gland with the scissors and pushed the scissors toward the nipple base as close as possible with the blades kept open. After that, we resected the nipple base using the scissors on pulling the mammary gland toward the opposite direction of the nipple. Frozen section and postoperative pathological study showed clear surgical margins and no lymph node metastasis. The patient developed temporary superficial dermal necrosis of the nipple but healed without leaving any sequelae in the nipple-areolar complex. The patient has been well for 20 months without any recurrences.
Our nipple-preserving techniques enable safe nipple preservation even for breast cancer patients with slight nipple retraction.
长期以来，乳头回缩一直被视为乳腺癌手术中保留乳头的绝对禁忌因素。
一名62岁女性因轻度乳头回缩的乳腺癌被转诊至我院。影像学检查结果显示，癌组织既未直接浸润乳头乳晕复合体，也无淋巴结病变。由于患者强烈要求，我们尝试如下保留乳头乳晕复合体。首先，我们以厚皮瓣的方式制作了一个除乳头乳晕复合体区域外的准完整皮瓣。其次，我们将乳头下方的乳腺组织完全骨骼化。接下来，我们用剪刀夹住骨骼化的乳头下方乳腺组织，并在剪刀刀片张开的情况下尽可能将剪刀推向乳头基部。之后，我们在将乳腺组织向乳头相反方向牵拉的同时，用剪刀切除乳头基部。冰冻切片和术后病理研究显示手术切缘清晰，无淋巴结转移。患者乳头出现暂时性浅表真皮坏死，但乳头乳晕复合体愈合后未留下任何后遗症。患者已健康存活20个月，无任何复发迹象。
我们的乳头保留技术即使对于轻度乳头回缩的乳腺癌患者也能实现安全的乳头保留。
