A Case of Paget's Disease Developed after Nipple-sparing Mastectomy and Implant Breast Reconstruction

Abstract

We report a case of Paget's disease of the breast developed after nipple-sparing mastectomy and breast reconstruction which is extremely rare. The case involved a 62-year-old woman who had undergone nipple-sparing mastectomy, sentinel lymph node biopsy and insertion of a tissue expander for right breast cancer (T2N0M0 Stage IIA) at our hospital 9 years previously. Two years later she underwent implant breast reconstruction where the tissue expander was replaced with an implant. She received hormonal therapy for 6 years after the first surgery, and thereafter she had been followed by periodic examinations. When she was 62 years old, or 9 years after the first surgery, she noticed skin erythema and ulcer around the right nipple and areola. Skin biopsy of the areola confirmed Paget's disease. Right nipple and areola resection and sentinel lymph node biopsy were performed for Paget's disease. She has been followed up in our clinic. Paget's disease of the breast is comparatively rare, but if we perform nipple-sparing mastectomy and implant breast reconstruction, we should bear the possibility of Paget's disease in mind, carefully consider the indications, and follow up the patient for longtime after surgery.