Pregnancy-Associated Breast Changes after Nipple-Sparing Mastectomy.
Journal
Plastic and reconstructive surgery
ISSN: 1529-4242
Titre abrégé: Plast Reconstr Surg
Pays: United States
ID NLM: 1306050
Informations de publication
Date de publication:
01 09 2023
01 09 2023
Historique:
medline:
1
9
2023
pubmed:
3
2
2023
entrez:
2
2
2023
Statut:
ppublish
Résumé
Women of reproductive age are chronically underrepresented in breast cancer studies. Recent studies suggest that almost 40% of patients diagnosed with breast cancer who are of reproductive age want to have children after completing treatment. In this study, the authors evaluated patients of reproductive age who had undergone nipple-sparing mastectomy (NSM) and implant-based reconstruction. The authors compared those who became pregnant with those who did not with respect to clinical and radiologic changes that are reported at follow-up. Any patient 45 years of age or younger at the time of NSM was determined to be of reproductive age, selected for evaluation, and followed prospectively. The presence or absence of breast examination changes in the setting of pregnancy after NSM was recorded. A total of 36 patients became pregnant after NSM, and 158 patients did not become pregnant after NSM. Of those who became pregnant, nearly half reported some clinical change just before or immediately after delivery. These changes included color change and discharge at the residual nipple-areola complex and palpable nodularity elsewhere. For those with palpable changes, an ultrasound was performed and hypoechoic lesions with variable vascularity were identified. For those who went on to excision, lactational hyperplasia was the most common diagnosis. Ultrasound is an appropriate first-line investigation of breast changes, which can include hyperplasia of remaining ductal and glandular tissue. Patients who became pregnant after NSM commonly had clinical breast examination changes, but the majority of these changes were found to be benign on further evaluation. Risk, II.
Sections du résumé
BACKGROUND
Women of reproductive age are chronically underrepresented in breast cancer studies. Recent studies suggest that almost 40% of patients diagnosed with breast cancer who are of reproductive age want to have children after completing treatment. In this study, the authors evaluated patients of reproductive age who had undergone nipple-sparing mastectomy (NSM) and implant-based reconstruction. The authors compared those who became pregnant with those who did not with respect to clinical and radiologic changes that are reported at follow-up.
METHODS
Any patient 45 years of age or younger at the time of NSM was determined to be of reproductive age, selected for evaluation, and followed prospectively. The presence or absence of breast examination changes in the setting of pregnancy after NSM was recorded.
RESULTS
A total of 36 patients became pregnant after NSM, and 158 patients did not become pregnant after NSM. Of those who became pregnant, nearly half reported some clinical change just before or immediately after delivery. These changes included color change and discharge at the residual nipple-areola complex and palpable nodularity elsewhere. For those with palpable changes, an ultrasound was performed and hypoechoic lesions with variable vascularity were identified. For those who went on to excision, lactational hyperplasia was the most common diagnosis.
CONCLUSIONS
Ultrasound is an appropriate first-line investigation of breast changes, which can include hyperplasia of remaining ductal and glandular tissue. Patients who became pregnant after NSM commonly had clinical breast examination changes, but the majority of these changes were found to be benign on further evaluation.
CLINICAL QUESTION/LEVEL OF EVIDENCE
Risk, II.
Identifiants
pubmed: 36727812
doi: 10.1097/PRS.0000000000010199
pii: 00006534-990000000-01516
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
492-500Informations de copyright
Copyright © 2023 by the American Society of Plastic Surgeons.
Références
Centers for Disease Control and Prevention. Breast cancer in young women. Available at: https://www.cdc.gov/cancer/breast/young_women/index.htm . Accessed April 12, 2021.
American Cancer Society. Breast Cancer Facts & Figures 2019-2020. American Cancer Society; 2019.
Quan ML, Paszat LF, Fernandes KA, et al. The effect of surgery type on survival and recurrence in very young women with breast cancer. J Surg Oncol. 2017;115:122–130.
Chen H-L, Zhou M-Q, Tian W, Meng K-X, He H-F. Effect of age on breast cancer patient prognoses: A population-based study using the SEER 18 database. PLoS One 2016;11:e0165409.
Ruddy KJ, Gelber SI, Tamimi RM, et al. Prospective study of fertility concerns and preservation strategies in young women with breast cancer. J Clin Oncol. 2014;32:1151–1156.
Dent BL, Miller JA, Eden DJ, Swistel A, Talmor M. Tumor-to-nipple distance as a predictor of nipple involvement: Expanding the inclusion criteria for nipple-sparing mastectomy. Plast Reconstr Surg. 2017;140:1e–8e.
Headon HL, Kasem A, Mokbel K. The oncological safety of nipple-sparing mastectomy: A systematic review of the literature with a pooled analysis of 12,358 procedures. Arch Plast Surg. 2016;43:328–338.
Smith BL, Tang R, Rai U, et al. Oncologic safety of nipple-sparing mastectomy in women with breast cancer. J Am Coll Surg. 2017;225:361–365.
Paluch-Shimon S, Cardoso F, Partridge A, et al. ESO-ESMO 4th international consensus guidelines for breast cancer in young women (BCY4). Ann Oncol. 2020;31:674–696.
Tang R, Kelly BN, Smith BL, et al. Nipple Discharge after nipple-sparing mastectomy with and without associated pregnancy. Clin Breast Cancer 2019;19:e534–e539.
Huston TL, Small K, Swistel AJ, Dent BL, Talmor M. Nipple-sparing mastectomy via an inframammary fold incision for patients with scarring from prior lumpectomy. Ann Plast Surg. 2015;74:652–657.
Key T, Appleby P, Reeves GK, et al.; Endogenous Hormones and Breast Cancer Collaborative Group. Sex hormones and risk of breast cancer in premenopausal women: A collaborative reanalysis of individual participant data from seven prospective studies. Lancet Oncol. 2013;14:1009–1019.
Lambertini M, Kroman N, Ameye L, et al. Long-term safety of pregnancy following breast cancer according to estrogen receptor status. J Natl Cancer Inst. 2018;110:426–429.
Partridge A, Pagani O, Abulkhair O, et al. First international consensus guidelines for breast cancer in young women (BCY1). Breast 2014;23:209–220.
Sabate JM, Clotet M, Torrubia S, et al. Radiologic evaluation of breast disorders related to pregnancy and lactation. Radiographics 2007;27:S101–S124.
Vashi R, Hooley R, Butler R, Geisel J, Philpotts L. Breast imaging of the pregnant and lactating patient: Physiologic changes and common benign entities. Am J Roentgenol. 2013;200:329–336.
de Holanda AAR, da Silveria Goncalves AK, de Medeiros RD, de Oliveira AMG, de Oliveira Maranhao TM. Ultrasound findings of the physiological changes and most common breast diseases during pregnancy and lactation. J Adiologia Brasileira 2016;49:389–396.
Yu JH, Kim MJ, Cho H, Liu HJ, Han S-J, Ahn T-G. Breast diseases during pregnancy and lactation. Obstet Gynecol Sci. 2013;56:143–159.
Wu Z-Y, Kim H-J, Lee J-W, et al. Breast cancer recurrence in the nipple-areola complex after nipple-sparing mastectomy with immediate breast reconstruction for invasive breast cancer. JAMA Surg. 2019;154:1030–1037.
Moo TA, Pinchinat T, Mays S, et al. Oncologic outcomes after nipple-sparing mastectomy. Ann Surg Oncol. 2016;23:3221–3225.
Yi M, Kronowitz SJ, Meric-Bernstam F, et al. Local, regional, and systemic recurrence rates in patient undergoing skin-sparing mastectomy compared with conventional mastectomy. Cancer 2011;117:916–924.
Janerich DT. The fetal antigen hypothesis for breast cancer, revisited. Med Hypoth. 1994;43:105–110.
Vaughan A, Dietz JR, Aft R, et al. Patterns of local breast cancer recurrence after skin-sparing mastectomy and immediate breast reconstruction. Am J Surg. 2007;194:438–443.
Gokhale S. Ultrasound characterization of breast masses. Indian J Radiol Imaging 2009;19:242–247.
Haliloglu N, Ustuner E, Ozkavukcu E. Breast ultrasound during lactation: Benign and malignant lesions. Breast Care 2019;14:30–34.
Ahn BY, Kim HH, Moon WK, et al. Pregnancy- and lactation-associated breast cancer: Mammographic and sonographic findings. J Ultrasound Med. 2003;22:491–497.
Loi S, Milne RL, Friedlander ML, et al. Obesity and outcomes in premenopausal and postmenopausal breast cancer. Cancer Epidemiol Prev Biomarkers 2005;14:1686–1691.