Nipple-sparing mastectomy and immediate breast reconstruction by prepectoral implant for the management of giant phyllodes tumors: A case series

Abstract

Phyllodes tumor is an uncommon breast neoplasm that is present in variable sizes. Giant phyllodes are those larger than 10 cm in diameter. Clinically, giant phyllodes tumors present as a visible, rapidly growing mass distorting the breast contour. Such tumors with large size and rapid growth rate suggest a phyllode diagnosis of fibroadenoma. Planning a standard treatment strategy for these tumors is quite challenging. While adequate surgical excision with tumor-free resection margins is the standard of care for most giant phyllodes cases, borderline and malignant giant phyllodes tumors might require wider resections given their high recurrence rates. Some authors described total mastectomy as the treatment option for giant borderline and malignant phyllodes to obtain wide, clear margins. Between March 2022 and September 2023, our surgical oncology department presented and operated on three cases of giant phyllodes. They underwent a nipple-sparing mastectomy and immediate breast reconstruction using pre-pectoral silicone implants. We think that with such a procedure, we can benefit from the wide, safe margins of mastectomy that have been proven to decrease local recurrence rates while considering the aesthetic outcome.

Keywords: Giant phyllodes; breast reconstruction; pre-pectoral implant; recurrence.

Fig. 1.

Preoperative and postoperative photos for Case 1: A. Preoperative photo showing right breast mass. B. Postoperative outcome after reconstruction.

Fig. 2.

Preoperative and postoperative photos for Case 2: A. Preoperative photo showing right breast mass. B. Preoperative incision design (batwing mammoplasty). C. Postoperative outcome after reconstruction.

Fig. 3.

Preoperative and postoperative photos for Case 3: A. Preoperative photo showing right breast mass. B. Preoperative incision design (right skin-reducing mastectomy with left reduction mammoplasty). C. Postoperative outcome after reconstruction.