A Case of Paget's Disease after Nipple-sparing Mastectomy

Abstract

A 61-year-old woman underwent nipple-sparing mastectomy and sentinel lymph node biopsy with tissue expander insertion for left breast cancer (TisN0M0 Stage 0) at our hospital 6 years prior. About eight months later, she underwent silicone implant replacement surgery. No adjuvant therapy was administered after surgery, and the patient was followed-up every three months with annual imaging tests. Five years after the surgery, she developed erosion of the left nipple-areolar region ; however, imaging tests did not lead to a diagnosis of local recurrence. The patient's condition was treated as contact dermatitis. However, in the sixth year, a subcutaneous mass was detected on ultrasound, and the erosion expanded. Skin biopsy was performed, and Paget's disease was diagnosed. Nipple-areolar excision, sentinel lymph node biopsy, and tissue expander insertion were also performed. Here, we report a case of breast Paget's disease after nipple-sparing mastectomy and breast implant reconstruction. Paget's disease is relatively rare and is the second reported case of breast reconstruction in Japan. With the increase in breast reconstruction cases in Japan, we believe that it is important to actively perform skin biopsies for nipple lesions after nipple-sparing mastectomy, considering the occurrence of Paget's disease.