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Case Reports
. 2022 May 20;10(5):e05812.
doi: 10.1002/ccr3.5812. eCollection 2022 May.

Double purse-string suture surgical wound closure after excision of nipple adenoma of the breast: A case report

Kanelina Bimpa  1 , Theodosia Charitou  1 , Apostolos C Ziogas  2 , Konstantinos Kantounis  3 , Emmanouil Xydias  2 , Mattheos Bobos  4   5 , Elias Tsakos  1
Affiliations
Case Reports

Double purse-string suture surgical wound closure after excision of nipple adenoma of the breast: A case report

Kanelina Bimpa et al. Clin Case Rep. .

Abstract

We present a rare case of nipple adenoma in a 53-year-old Caucasian woman. The lesion presented with a hemorrhagic nipple surface and was treated with wide surgical excision of the nipple and part of the surrounding areola and with a double purse-string surgical closure of the remaining areolar area. This technique was considered safe and effective and aimed to reconstruct the nipple area, thus providing the patient with an acceptable aesthetic result. Double purse-string surgical closure is proposed as a unique and straightforward, oncologically safe surgical procedure. This technique combines complete removal of the nipple adenoma, preservation of the remaining areola, minimization of skin flattening at the reconstructed area, improvement of the long-term aesthetic result, and provision of a satisfactory surgical option for the patient.

Keywords: breast; case report; nipple; nipple adenoma; nipple and areaola reconstruction.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

FIGURE 1
FIGURE 1
Large panel. Whole scanned microphotograph from the resection specimen stained with hematoxylin and eosin showed benign proliferative epithelial lesion on the nipple area with nodular architecture, consisted of papillary, solid, and cribriform structures. Small panel. Immunohistochemistry using the cocktail p63/h‐Caldesmon document the presence of myoepithelial component of the lesion, whereas smooth muscle bundles on the stroma are highlighted with the h‐Caldesmon marker. Papillary carcinomas lack myoepithelial cells
FIGURE 2
FIGURE 2
Complete resection of the nipple before and after double purse‐string closure. (A) Preoperative photograph of patient's breast showing nipple adenoma and marks. (B) Application of DPS after complete removal of the left nipple. (C) Follow‐up check, 4 months after the DPS procedure
FIGURE 3
FIGURE 3
Step‐by‐step illustration of the DPS technique. (A) Marking of the area to be excised (inner, continuous circle), this margin will close with the upper suture of the DPS. Marking of a second area at a distance equal to the desired projection of the new nipple (outer, broken circle), this will form the basis of the new nipple and will close with the lower/second suture. (B) Surgical excision of the marked area, containing the adenoma and adequate surrounding tissues. (Ci) (anterior view) and (Cii) (side view): closure of the wound. Inner circle is closed completely by a purse‐string suture and forms the top of the nipple. The outer circle is closed by a second purse‐string suture lower than the first one. The distance between the two creates a projection resembling the normal, contralateral nipple. (D) Final reconstructed nipple at follow‐up. Despite some minimal flattening, there was adequate projection, along with the radial appearance of the area to maintain an aesthetically pleasing result
See this image and copyright information in PMC

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