Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2014 Dec 5;2(11):e253.
doi: 10.1097/GOX.0000000000000189. eCollection 2014 Nov.

A Novel Approach to the Management of Margin-positive DCIS in Nipple-sparing Mastectomy

Hilton Becker  1 , Mary Ellen Billington  1
Affiliations
Case Reports

A Novel Approach to the Management of Margin-positive DCIS in Nipple-sparing Mastectomy

Hilton Becker et al. Plast Reconstr Surg Glob Open. .

Abstract

Nipple-sparing mastectomy (NSM) is gaining acceptance as an oncologically sound and cosmetically superior mastectomy technique. Debate exists over the management of positive margins near the nipple-areola complex. This case report presents a novel approach to the management of margin-positive ductal carcinoma in situ in NSM. A 50-year-old white female with invasive ductal carcinoma underwent NSM. Intraoperative pathology indicated the presence of DCIS-positive retroareolar margins. Revision through a direct vertical nipple incision allowed for adequate surgical revision and pathologic evaluation of the retroareolar breast tissue while maintaining the nipple-areola skin and primary mastectomy incision. This novel approach ensures negative margins, allows superior cosmetic outcome, and improves patient autonomy in decision making. The technique may translate to NSM patients with positive retroareolar margins or false-negative margins.

PubMed Disclaimer

Conflict of interest statement

Disclosure: Dr. Hilton Becker is a paid consultant for Mentor Worldwide and Greer Medical. Dr. Billington has nothing to declare. The Article Processing Charge was paid for by the authors.

Figures

Fig. 1.
Fig. 1.
Before NSM: vertical scars from previous right lumpectomy and bilateral mastopexy are noted.
Fig. 2.
Fig. 2.
Right nipple: incision down to acellular dermal matrix, illustrating good visualization of the subareolar tissue.
Fig. 3.
Fig. 3.
Closure of the right nipple after tissue removal: the nipple has been reapproximated with good cosmetics and nipple viability noted.
Fig. 4.
Fig. 4.
Final Result at 3 months. A, Front. B, Oblique. C, Front, no animation deformity.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. DeSantis CE, Lin CC, Mariotto AB, et al. Cancer treatment and survivorship statistics, 2014. CA Cancer J Clin. 2014;64:252–271. - PubMed
    1. Wagner JL, Fearmonti R, Hunt KK, et al. Prospective evaluation of the nipple-areola complex sparing mastectomy for risk reduction and for early-stage breast cancer. Ann Surg Oncol. 2012;19:1137–1144. - PMC - PubMed
    1. Lohsiriwat V, Rotmensz N, Botteri E, et al. Do clinicopathological features of the cancer patient relate with nipple areolar complex necrosis in nipple-sparing mastectomy? Ann Surg Oncol. 2013;20:990–996. - PubMed
    1. Paepke S, Schmid R, Fleckner S, et al. Subcutaneous mastectomy with conservation of the nipple-areola skin: broadening the indications. Ann Surg. 2009;250:288–292. - PubMed
    1. de Alcantara Filho P, Capko D, Barry JM, et al. Nipple-sparing mastectomy for breast cancer and risk-reducing surgery: the Memorial Sloan-Kettering Cancer Center experience. Ann Surg Oncol. 2011;18:3117–3122. - PubMed

Publication types

LinkOut - more resources