Operative Approaches to Nipple-Sparing Mastectomy: Indications, Techniques, & Outcomes PDF
Preview Operative Approaches to Nipple-Sparing Mastectomy: Indications, Techniques, & Outcomes
Operative Approaches to Nipple-Sparing Mastectomy Indications, Techniques, & Outcomes Jay K. Harness Shawna C. Willey Editors 123 Operative Approaches to Nipple-Sparing Mastectomy Jay K. Harness (cid:129) Shawna C. Willey Editors Operative Approaches to Nipple-Sparing Mastectomy Indications, Techniques, & Outcomes Editors Jay K. Harness, MD, FACS Shawna C. Willey, MD, FACS Center for Cancer Prevention and Professor of Clinical Surgery Treatment Director, MedStar Regional Breast St. Joseph Hospital, Orange, CA, USA Health Program Vice-Chair, Department of Surgery Clinical Professor of Surgery MedStar Georgetown University Department of Surgery Hospital University of California Irvine Medical Washington , DC , USA Center Orange , CA , USA ISBN 978-3-319-43257-1 ISBN 978-3-319-43259-5 (eBook) DOI 10.1007/978-3-319-43259-5 Library of Congress Control Number: 2016955848 © Springer International Publishing Switzerland 2017 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. Printed on acid-free paper This Springer imprint is published by Springer Nature The registered company is Springer International Publishing AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland Foreword It is a special privilege to write the foreword to this text on nipple-sparing mastectomy edited by Shawna Willey and Jay Harness. It would be hard to overestimate how powerful and revolutionary the adoption of this technique has been to the management of breast cancer. In the fi rst edition published in 1998 of my seminal multidisciplinary textbook, Surgery of the Breast: Principles and Art, there were no chapters on Nipple-Sparing Mastectomy, and the chapter on Prophylactic Mastectomy specifi cally recommended against retaining the nipple. Although Breast Conservation, where the remaining breast skin and nipple are retained and radiated, had been widely adopted earlier, there was a peculiar resistance regarding preserving the nip- ple and the breast skin envelope when the entire breast gland had been removed but not radiated. To the best of my knowledge, the fi rst big chink in the anti-nipple preservation armor came with the publication by Lynn Hartmann in the 1999 N ew England Journal of Medicine Volume 340 describ- ing a 90 % plus reduction in the risk of developing breast cancer after prophy- lactic mastectomy, over 90 % of which were nipple sparing. Preserving the nipple and skin of the breast became a mission for the cou- rageous early adopters. And so it started with prophylactic nipple-sparing mastectomy for ideal anatomical candidates who had the recently identifi ed Breast Cancer genes (BRCA 1 and 2). Then came mastering mastectomy techniques in order to limit the risk of necrosis. Within a few years, the enve- lope got pushed to include some breast cancer patients. Then the criteria in cancer patients were expanded to include more advanced cancers so long as the nipple margins were clean. Innovations continued expanding nipple- sparing mastectomy to larger breasts, ptotic breasts, and even previously radi- ated breasts. We are now over 10 years into this nipple-sparing mastectomy revolution and the effects have been extraordinary. A great many women have been spared the mutilation previously associated with other forms of mastectomy. In many centers and in the hands of many breast cancer teams, it is not at all unusual for women to end up after treatment with breasts that appear normal, natural, beautiful, and often more so than preoperatively. The power of this long overdue innovation is evident to surgeons every day with the often tear- ful “Thank yous” that they hear from their patients. This last weekend, I was personally approached by two separate breast cancer survivors having under- gone nipple-sparing mastectomies with reconstruction who thanked me for my contribution in making this treatment happen. v vi Foreword We are 10 years or so into the data collection phase of this treatment, and the data have been uniformly encouraging. With experience, complication rates can be low. Patients who were facing the fear of deformity after breast cancer treatment are actually relieved and usually happy with how they look. And most importantly, breast cancer recurrence rates remain low and are very, very, low in the nipple. And so, this volume edited by Doctors Harness and Willey arrives at the right moment to provide 23 separate chapters on the subject. I look forward to reading each of these chapters which all give testimony to how far we have come in a relatively short time. Scott L. Spear Professor of Surgery Georgetown University Chevy Chase MD, USA Pref ace For more than a decade, there has been a growing interest in the preservation of the nipple-areolar complex at the time of skin-sparing mastectomy for the treatment or prevention of breast cancer. Increasing numbers of papers have appeared in the literature reporting institutional experiences as well as vari- ous review articles on nipple-sparing mastectomy (NSM), which is also called total skin-sparing mastectomy (TSSM) by some authors. These publi- cations describe various surgical approaches to NSM, patient selection crite- ria, complication rates, and plastic surgery issues concerning reconstruction. What is n ot available is a s ingle source summarizing the approach and out- comes from several of those centers that have evolved NSM as an option in women who need or desire a mastectomy for the treatment or prevention of breast cancer. This textbook is the fi rst of its kind. It is designed to present a comprehen- sive overview of the evolution, oncologic safety, surgical approaches, man- agement of complications, and outcomes of NSM. The book reviews various approaches to the performance of NSM from highly experienced authors. The book examines the expanding indications for NSM, evolving operative and reconstruction techniques, increasing patient satisfaction, and longer follow- up data on safety and low recurrence rates. T he book is targeted at general surgeons, dedicated breast surgeons, and plastic surgeons. There is a focus for surgeons just beginning their use of NSM as well as a review of patient selection criteria, operative approaches, reconstruction options, and management of complications. The chapters are written by experts in the performance and reconstruction of NSM. Chapters are supplemented with appropriate illustrations and photos of NSM and TSSM techniques and reconstructions. W e hope that our textbook will become a valuable resource for surgeons, including those in training, who have a focus on state-of-the-art breast cancer surgery. Orange, CA, USA Jay K. Harness Washington, DC, USA Shawna C. Willey vii Contents 1 The Evolution of Nipple-Sparing Mastectomy (NSM) .............. 1 Jay K. Harness 2 Nipple and Breast Anatomy ......................................................... 11 Jennifer Rusby and Riaz Agha 3 Patient Selection and Breast Imaging ......................................... 21 Rubie Sue Jackson , Robert Buras , and Lorraine Tafra 4 The Inframammary Approach to Nipple-Sparing Mastectomy: The Georgetown University Hospital Experience ..................................................................................... 37 Scott L. Spear , Ryan Mathis , Frank P. Albino , and Troy A. Pittman 5 The Inframammary Approach to Nipple-Sparing Mastectomy: The UCSF Experience ........................................... 47 Anne Warren Peled and Michael D. Alvarado 6 The Vertical Infra-Areolar Approach to Nipple Skin-Sparing or Total Skin-Sparing Mastectomy ...................... 53 Amy Rivere , Pallavi Archana Kumbla , and V. Suzanne Klimberg 7 Nipple-Sparing Mastectomy in the Large, Ptotic Breast........... 67 Arthur H. Salibian , J ay K. Harness , and Donald S. Mowlds 8 Nipple-Sparing Mastectomy in the Community Setting ........... 75 Donald S. Mowlds , Jay K. Harness , Arthur H. Salibian , and Richard S. McNally 9 Reducing Complications and Margin Issues with Nipple- Sparing Mastectomy ................................................ 85 Alice P. Chung and Armando E. Giuliano 10 Techniques to Avoid Nipple and Flap Necrosis .......................... 101 Alan Stolier 11 Using the Breast Reconstruction Risk Assessment (BRA) Score: An Individualized Risk Calculator to Assist Expectation Management and Reconstructive Decision Making in the Mastectomy Patient .............................. 117 Alexei S. Mlodinow , Steven T. Lanier , Robert D. Galiano , and John Y. S. Kim ix x Contents 12 Plastic Surgery Considerations in Reconstruction After Nipple- Sparing Mastectomy .............................................. 127 Steven J. Kronowitz 13 Acellular Dermal Matrices: To Use or Not? ............................... 135 Maurice Y. Nahabedian 14 Prepectoral Reconstruction with Acellular Dermal Matrix (ADM) Strattice® ................................................ 147 Roland Reitsamer 15 Subcutaneous Reconstruction Without Acellular Dermal Matrix ............................................................................... 157 Arthur H. Salibian , Jay K. Harness , and Donald S. Mowlds 16 Nipple-Sparing Mastectomy in the Previously Radiated Patient ............................................................................ 165 Eleni Tousimis and Lindsay Potdevin 17 Experience with Postmastectomy Radiation Therapy in Nipple- Sparing Mastectomy .................................................... 175 Hani Sbitany 18 Management of Complications Following Nipple-Sparing Mastectomy .................................................................................... 185 K. C. Chu and Albert Losken 19 Fluorescence Imaging in Breast Reconstruction: Minimizing Complications and Improving Outcomes .............. 195 Troy A. Pittman , Chrisovalantis Lakhiani , and Kenneth L. Fan 20 The Science Behind Fat Grafting and Acellular Dermal Matrices ............................................................................ 209 Steven J. Kronowitz 21 The Team Approach to Nipple- Sparing Mastectomy and Reconstruction ....................................................................... 217 Toni Storm-Dickerson , G. Patrick Maxwell , Pat Whitworth , and Allen Gabriel 22 The Intraoperative Team Approach to Nipple-Sparing Mastectomy .................................................................................... 229 Arthur H. Salibian and Jay K. Harness 23 The American Society of Breast Surgeons Nipple-Sparing Mastectomy Registry .................................................................... 235 Sunny D. Mitchell and Peter D. Beitsch Index ....................................................................................................... 249 Contributors Riaz Agha , B.Sc. (Hons), M.B.B.S., M.R.C.S. (Eng) Department of Plastic Surgery , Guy’s and St. Thomas’ NHS Foundation Trust , London , UK Frank P. Albino , M.D. Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC, USA Michael D. Alvarado , M.D. Department of General Surgery , University of California , San Francisco , CA , USA Peter D. Beitsch , M.D. Department of Surgery , Dallas Medical Center , Dallas , TX , USA Robert Buras , M.D., F.A.C.S. The Rebecca Fortney Breast Center, Anne Arundel Medical Center, Annapolis, MD, USA K. C. Chu , M.D. G eneral Surgery, Plastic Surgery, E mory Division of Plastic and Reconstructive Surgery , Atlanta , GA , USA Alice P. Chung , M .D., F.A.C.S. Department of Surgery , Cedars-Sinai Medical Center , Los Angeles , CA , USA Kenneth L. Fan , M.D. Department of Plastic and Reconstructive Surgery , MedStar Georgetown University Hospital , Washington , DC , USA Allen Gabriel , M.D. Loma Linda University Medical Center , Loma Linda , CA , USA Peacehealth Medical Group , Vancouver , WA , USA Robert D. Galiano , M.D. Division of Plastic Surgery , Feinberg School of Medicine of Northwestern University , Chicago , IL , USA Armando E. Giuliano , M.D., F.A.C.S., F.R.C.S. (Ed.) Department of Surgery , Cedars-Sinai Medical Center , Los Angeles , CA , USA Jay K. Harness , M.D., F.A.C.S. Center for Cancer Prevention and Treatment , St. Joseph Hospital, Orange , CA , USA Clinical Professor of Surgery, Department of Surgery, University of California Irvine Medical Center, Orange, CA, USA Rubie Sue Jackson , M.D., M.P.H. The Rebecca Fortney Breast Center, Anne Arundel Medical Center, Annapolis, MD, USA xi
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