Feasible Nipple Preservation Techniques for Breast Cancer With Suspected Ductal Spread to the Nipple Base on Imaging: A Case Report

Possible ductal spread to the nipple base on imaging generally leads breast surgeons to perform either partial mastectomy, including nipple resection, or total mastectomy in breast cancer patients. Our nipple base resection techniques, however, can provide safe nipple preservation for many breast cancer patients, even when imaging suggests ductal spread to the nipple base. An 86-year-old woman with breast cancer near the nipple-areolar complex showed suspected ductal spread to the nipple base on preoperative imaging. Due to the patient’s strong preference for nipple preservation, she underwent nipple preservation using our techniques as follows. A spindle skin resection was performed just above the breast cancer and connected to the peri-areolar incision, followed by skin flap formation in a thick-flap manner, extending to areas sufficient for partial mastectomy. A partial mastectomy was performed with an incision of the mammary gland distal to the tumor, blunt dissection of the retro-mammary space around the breast cancer using fingers, further incision of the mammary gland toward the nipple under palpation of the breast cancer to avoid an off-center partial mastectomy, and complete skeletonization of the sub-nipple mammary gland. Thereafter, the nipple base was resected with scissors while the nipple was slightly depressed by pulling the partial mastectomy tissue. These procedures led to quasi-complete resection of the target mammary gland, showed pathologically negative margins at the nipple base, and caused no complications to the nipple-areolar complex. The patient has been well for six months on endocrine therapy without adjuvant radiotherapy due to both her advanced age and her preference. Breast surgeons should note that our nipple preservation techniques can safely preserve the nipple even in cases of breast cancer with suspected ductal spread to the nipple base on imaging.