Breast-conserving Surgery with Extraction of the Nipple and Partial Resection of the Areola for Early Breast Cancer—A Report of Four Cases—

Abstract

We have performed breast-conserving surgery with extraction of the nipple and partial resection of the areola for four cases of early breast cancer in which nipple involvement of breast cancer was suspected.

Before surgery, cancer involvement into the nipple was determined by contrast-enhanced MRI images in all four cases. The case 1 was of Paget's disease in which the entire nipple was enhanced on MRI. In the case 2, a huge tumor was present just under the inverted nipple, and a part of the nipple extending until its base was enhanced. In the case 3, diffusive enhancement circling around the nipple base was seen, suggesting a possible existence of invasive cancer nest. In the case 4, we confirmed intraductal progression in the direction toward the nipple to form a nodular image in the nipple and we determined that there was a possibility of nipple involvement. The case 2 was of encapsulated papilloma including ductal carcinoma in situ. Pathological studies demonstrated invasive cancer nest within the nipple in the case 3, but not in the case 4. In all cases surgical stumps were negative and postoperative irradiation was combinedly used.

In all cases, we performed breast-conserving surgery, comprising extraction of the nipple, associated resection of the areolar skin and subcutaneous structure which situated just above the subareolar lesion, and full thickness resection until fascia of pectoralis major muscle including the nipple and areola. As a spindle-shaped skin incision wound was closed with continuous buried sutures, a dog ear was formed on the areola which expanded like a nipple in shape, and so natural color of the areola skin has been kept.