1
|
Kimura M, Narui K, Shima H, Ikejima S, Muto M, Satake T, Tanabe M, Inayama Y, Adachi S, Yamada A, Shimada K, Sugae S, Ichikawa Y, Ishikawa T, Endo I. Development of an invasive ductal carcinoma in a contralateral composite nipple graft after an autologous breast reconstruction: a case report. Surg Case Rep 2020; 6:203. [PMID: 32770432 PMCID: PMC7415053 DOI: 10.1186/s40792-020-00962-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 07/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nipple-areola complex (NAC) reconstruction is a technique used in breast reconstructive surgery, which is performed during the final stage of breast reconstruction after total mastectomy of primary breast cancer. Composite nipple grafts utilizing the contralateral NAC are common; however, to our knowledge, there are no reports of new primary invasive ductal carcinoma development within the graft. Here, we describe one such case for the first time. CASE PRESENTATION A 54-year-old woman was referred to us by the Department of Plastic and Reconstructive Surgery in our medical center for further evaluation of right nipple erosion. She had undergone total mastectomy of the right breast following a breast cancer diagnosis 15 years ago, at which time tumor biological profiling revealed the following: estrogen receptor (ER), positive; progesterone receptor (PgR), negative; and human epidermal growth factor receptor 2 (HER2), undetermined. She received adjuvant chemotherapy and endocrine therapy. She defaulted endocrine therapy for a few years, and 7 years after surgery, she underwent autologous breast reconstruction with a deep inferior epigastric perforator (DIEP) flap. In the following year, NAC reconstruction was performed using a composite graft technique. Seven years after the NAC reconstruction, erosion appeared on the nipple grafted from its contralateral counterpart; scrape cytology revealed malignancy. The skin on the right side of her chest around the NAC and subcutaneous fat tissue consisted of transferred tissue from the abdomen, as the DIEP flap and grafted nipple were located on the graft skin. The right nipple carcinoma arose from the tissue taken from the left nipple. Magnetic resonance imaging (MRI) or computed tomography showed no malignant findings in the left breast. As the malignant lesion seemed limited to the area around the grafted right nipple on MRI, surgical resection with sufficient lateral and deep margins was performed around the right nipple. Pathological findings revealed invasive ductal carcinoma with comedo ductal components infiltrating the graft skin and underlying adipose tissue. Immunohistochemistry revealed positive for ER, PgR, and HER2. CONCLUSIONS To our knowledge, this is the first case involving the development of invasive ductal carcinoma in a nipple graft constructed on the skin of a DIEP flap, with the origin from the contralateral breast's nipple.
Collapse
Affiliation(s)
- Mariko Kimura
- Department of Breast and Thyroid Surgery, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan. .,Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
| | - Kazutaka Narui
- Department of Breast and Thyroid Surgery, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan
| | - Hidetaka Shima
- Department of Breast and Thyroid Surgery, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan
| | - Shizune Ikejima
- Department of Breast and Thyroid Surgery, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan
| | - Mayu Muto
- Plastic and Reconstructive Surgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Toshihiko Satake
- Plastic and Reconstructive Surgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Mikiko Tanabe
- Diagnostic Pathology, Yokohama City University Medical Center, Yokohama, Japan
| | - Yoshiaki Inayama
- Diagnostic Pathology, Yokohama City University Medical Center, Yokohama, Japan
| | - Shoko Adachi
- Department of Breast and Thyroid Surgery, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan
| | - Akimitsu Yamada
- Department of Breast and Thyroid Surgery, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan
| | - Kazuhiro Shimada
- Department of Breast and Thyroid Surgery, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan
| | - Sadatoshi Sugae
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yasushi Ichikawa
- Department of Oncology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Takashi Ishikawa
- Department of Breast Oncology and Surgery, Tokyo Medical University, Shinjuku, Tokyo, Japan
| | - Itaru Endo
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| |
Collapse
|
2
|
Cypel TK, Brown M. Twelve-year delay of a nipple-sharing graft: A case report. THE CANADIAN JOURNAL OF PLASTIC SURGERY = JOURNAL CANADIEN DE CHIRURGIE PLASTIQUE 2014; 21:190-1. [PMID: 24421653 DOI: 10.1177/229255031302100310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The present report describes the use of a nipple-sharing technique for nipple areolar reconstruction using a donor nipple that was initially grafted from the contralateral and healthy breast 12 years earlier. There are many different techniques available to reconstruct the nipple. Although nipple sharing is not feasible to use in all patients, when available, it is an ideal approach for matching the contralateral nipple in terms of shape, colour, texture and long-term projection.
Collapse
Affiliation(s)
| | - Mitchell Brown
- Women's College Hospital; ; Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto, Ontario
| |
Collapse
|