Nipple-sparing Mastectomy has Low Cancer Recurrence Rate

Nipple-sparing mastectomy had been controversial for the past decade.  Recently, a study showed that women who underwent nipple-sparing mastectomy had low breast cancer recurrence.  The study which was published in the Journal of American College of Surgeons revealed an overall cancer recurrence of 5.5 % at a median follow-up of 55 months.  No cancer recurrence occured in the retained nipple.

The study also showed that the disease-free survival rate was also high (95.7% ar 3 years and 92.3% at 5 years.)  Locoregional recurrence was 3.7% with no recurrence occured in the nipple.

Indications of Nipple Sparing Mastectomy

• Tumor size <3 cm
• Tumor >2 cm away from the nipple
• No axillary nodal involvement or negative Sentinel Lymph Node
• No skin involvement of Paget's disease
• Intraop and frozen section pathology of the breast tissue underneath the NAC are negative
• Pre-operative MRI imaging showed no nipple-areolar involvement

Breast reconstruction after Nipple-sparing Mastectomy

• Breast tissue expander followed by permanent breast implant placement
• Autologous reconstruction, such as DIEP flap
• Direct-implant reconstruction

Reference:  Oncologic Safety of Nipple Sparing Mastectomy in Women with Breast Cancer, Journal of the American College of Surgeons. DOI: http://dx.doi.org/10.1016/j.jamcollsurg.2017.06.013.

Emmanuel De La Cruz MD, PLLC

Plastic Surgeon, Houston texas

Breast Implant-Associated Anaplastic Large Cell Lymphoma

There are approximately 10 million women who underwent breast augmentation with breast implants in the whole world.  Currently, breast augmentation is the number 1 cosmetic procedure performed in the United States with approximately 500,000 implants placed every year.

Before & After Photos of Breast Augmentation using the Dual-Plane Technique performed by Dr. Emmanuel De La Cruz. 

Breast implant-associated anaplastic large cell lymphoma (ALCL) is a dinstinctive type of T-cell lymphoma that occurs after breast augmentation or enlargement.  This occurs around the breast implants itself.  Fortunately, this is a rare condition with approximately 258 cases that has been documented since 1997 (as of September 2015.) 

Clinical Findings and Symptoms of Patients who may potentially have ALCL:

• Persistent Seroma
• Seroma associated with breast pain or swelling
• Occurs an average of 9 years after breast augmentation
• All reported cases of breast implant-associated ALCL have involved textured breast implants

What are your risks for developing ALCL (Anaplastic Large Cell Lymphoma)?

• incidence varies from 0.1 and 0.3 per 100,000 women with breast implants per year.
• One in 100 million women per year in the general population (based on the data from the Surveillance, Epidemiology and End Results Program of the National Cancer Institute.)
• Lifetime prevalence was 33 per 1 million women with a textured breast implant or 1 per 30,000 women with a textured breast implant.

I recommend discussing your risks for development of ALCL with your plastic surgeon prior to having breast augmentation.

References:

Doren, et al.  US Epidemiology of Breast Implant-Associated Anaplastic Large Cell Lymphoma.  Plastic and Reconstructive Surgery. Volume 139 Number 5May 2017 pp104-1049

Emmanuel De La Cruz MD, PLLC

Plastic & Reconstructive Surgeon (Houston, TX)

Inverted Nipple Repair - Houston, Texas

Inverted Nipple Repair

Inverted nipples, or retraction of nipples, is a condition in which the nipple has the appearance of being tethered or pulled inwards.

The degree of inverted nipple can be a source of self-consciousness and breast feeding problems. This problem can occur in one or both breasts. 

Many women who experience this problem usually wear bras or clothing which do not emphasise the problem.  Nipple inversion is not rare, with reported prevalence ranging from 1.8 to 3.3%

Inverted Nipple

CAUSES OF INVERTED NIPPLE

• Breastfeeding
• Born with the condition
• Breast Cancer (Thus, one would need a mammogram if the inverted nipple is new onset)
• Breast infection/inflammation
• Pregnancy
• Gynecomastia
• Trauma

Mildly inverted nipples can be drawn out with physical stimulation, either sexually or for breast-feeding. 

Severely inverted nipples never project even when stimulated or in very cold water.

Apart from cosmetic concern, severe inversion may have functional repercussions, such as the inability to breast feed, infection or irritation of the nipple when natural secretions become trapped.

GRADING OF INVERTED NIPPLES

• Grade I - Inverted nipple may occasionally "pop out" without manipulation or pressure
• Grade II - Inverted nipple retracts after the pressure is released
• Grade III - Severely inverted nipples which cannot be pulled out physically and would require surgery

CORRECTION OF INVERTED NIPPLES WITH SURGERY

Many techniques have been reported for the correction of inverted nipples. However, the conventional methods may be insufficient, especially for moderate to severe inversions. The suspension technique is a simple, reliable method for correcting grade II and III nipple inversions. 

Reference:

Jeong H-S, Lee H-K (2015) Correction of Inverted Nipple Using Subcutaneous Turn-Over Flaps to Create a Tent Suspension-Like Effect. PLoS ONE 10(7): e0133588. doi:10.1371/journal.pone.0133588

Call for a FREE Consultation with Dr. De La Cruz at 832-776-1134.