Operative Approaches to Nipple-Sparing Mastectomy: Indications, Techniques, & Outcomes

256 Pages·2017·15.2 MB·English

by  Jay K. Harness

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
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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