Property | Value |
Name | Nipple-areola complex Sparingmastectomy in breast carcinoma: A clinico-pathological assessment to determine its feasibility in Indian population |
Description | Original article:- Plastic Surgery Madhumita Gupta1,AshwinPai2*,Sandipan Gupta3,Ravi R4, Raghavendra S5 & Aditya Kanoi6 1MS (Mch) , PDT ,2MS MRCSEdMRCSEng (Mch), PDT Dept of Plastic surgery , SSKM Hospital and IPGMER , Kolkata- 26,India. 3HOD,Dept of Plastic Surgery ,Medical college Hospital, Kolkata, India. 4,5,6 MS (Mch) PDT,Dept of Plastic surgery , SSKM Hospital and IPGMER , Kolkata- 26,India.
Abstract:- Background: The advent of skin–sparing mastectomy (SSM) with immediate breast reconstruction (IBR) as an established treatment option revolutionized the standard surgical management of breast carcinoma. However, it includesextirpation of the nipple-areola complex (NAC) that causes a feeling of mutilation which reconstruction cannot overcome.The present study is aimed at determining the pre-operative criteria that will guide the NAC preservation in selected patients of breast carcinoma. Methods: This multi-institution based observational prospective study was carried out in Kolkata, India between July 2007 to January 2012 with a study population comprising of 330 subjects. Histopathologically confirmed malignant involvement of the NAC in the mastectomy specimens was correlated with pre-operative clinical parameters like site (including areola-tumor distance), size of the tumor (T), skin involvement , palpable regional lymph nodes and histopathological parameters like size of the tumor (pT), skin involvement (pT), number of positive lymph nodes (pN), stage of the tumor (pTNM), histological type of the tumor, histological grade of the tumor. Chi-square analysis was done for different characteristics vis-à-vis NAC involvement. Two sided lists, wherever possible, had been performed at 5% level of significance and P-values were evaluated. Results: The total frequency of malignant involvement of the NAC was 115 (34.85%) of 330 cases. NAC was involved in only 15 (7.5%) of 200 patientswith peripherally located tumours(with areola-tumor distance >2.5 cm), compared with a huge 100 (76.92%) of 130 patients with tumours located in central or retro-areolar areas of the breast. Only 5 of 150 (3.33%) peripheral tumors <5 cm size had malignant NAC involvement, whereas 10 of 50 tumors(20%) >5 cm had so. However, even in tumors >5 cm with NAC involvement majority (45 of 55) were central in location.None of the 30 patients, having peripherally located tumours with skin infiltration, had any NAC involvement. Involvement of NAC in patients with stage III tumors(53.85%) is significantly more as compared to stage I & II tumors. However, the central tumors with NAC involvement grossly outnumbered the peripheral ones in all 3 stages. Histological type and grade showed no significant association with NAC involvement. Conclusion: NAC can be preserved in patients with peripheral tumours (particularly those ≤ 5 cm in size, and belonging to stages I and II), irrespective of their nodal status ,skin involvement, histological type and grade to improve the aesthetic outcome of immediate breast reconstruction.
Key words:- Skin-sparing mastectomy; Immediate breast reconstruction; Nipple-areola complex; Nipple - areola complex preservation. |
Filename | PaiAshwin et al.(182-188).pdf |
Filesize | 668.2 kB |
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Creator | admin |
Created On: | 12/03/2012 00:00 |
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Maintained by | Editor |
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Last updated on | 12/17/2012 06:57 |
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