1 / 44

“ Conservative mastectomy ” the nipple sparing tecnique

“ Conservative mastectomy ” the nipple sparing tecnique. Alberto Luini Senology Division European instiute of Oncology -Milan. Milan Conservation Programme (1970-2010). Conservation of the breast Conservation of axillary nodes Partial intraoperative radiotherapy (ELIOT)

edythe
Télécharger la présentation

“ Conservative mastectomy ” the nipple sparing tecnique

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. “Conservative mastectomy”the nipple sparing tecnique Alberto Luini SenologyDivision Europeaninstiute of Oncology-Milan

  2. Milan Conservation Programme (1970-2010) Conservation of the breast Conservation of axillary nodes Partial intraoperative radiotherapy (ELIOT) Conservative mastectomy+ELIOT Phase 1 - Phase 2 - Phase 3 - Phase 4 -

  3. Improvement in diagnosis (ultrasonography, MRI) total mastectomies EIO 2000 2005 23% 28% A.Luini

  4. Timing of Reconstruction - Always immediate - Delayed only if: - Locally advanced disease - Concomitant diseases A.Luini

  5. SSM + immediate reconstruction with prosthesis or expanderisnowadays the standard treatment, except for: • Inflammatorycancer • Locallyadvanceddisease • Poor general conditions A.Luini

  6. Skin Sparing Mastectomy + immediate reconstruction with prosthesis A. Luini

  7. Immediate reconstruction does not affect the prognosis A. Luini

  8. 677 Total mastectomies + adjuvant treatment (no RT) 518 immediate rec. 159 no rec. (76.5%) (23.5%) Median follow up 70 months (range 13-144) A. Luini

  9. Multivariate analysis (median f.u. 70 m.) (518 immediate reconstructions vs 159 without reconstruction) A. Luini Petit JY et al, Breast Cancer Res Treat, 2008

  10. Immediate reconstruction: The Nipple Sparing Approach EIO NSM 84% of the mastectomies A. Luini

  11. Multifocal/multicentric cancer • Extensive microcalcifications • Contraindications or refusal to primary medical treatment • Negative retroareolar frozen section Indications A. Luini

  12. Involvement of the central quadrant • Paget’s disease • Pathological nipple discharge • Microcalcifications close to the nipple • Previous radiotherapy Contraindications A. Luini

  13. Oncologic radicality: skin removal as a quadrantectomy and of the whole glandular tissue (except a thin retroareolar portion) • Intraoperative radiotherapy on the nipple areola complex (16Gy) • Immediate reconstruction with a good cosmetic result (very similar to a “good” quadrantectomy) Advantages A. Luini

  14. Subcutaneous mastectomy a fifty year old technique ! a layer of glandular tissue should be left beneath the NAC to avoid NAC necrosis A. Luini

  15. Surgical technique a) Conservation of the retroareolarglandulartissue b) Conservation of the retroareolarsubcutaneousvascularplexus

  16. Surgical technique a) Sterile LINAC collimator c) Lead and alluminium protective disc d) Pectoralis major muscle

  17. Nipple Sparing Mastectomy ELIOT (16 Gy) on the remaining glandular tissue to complete the cancer treatment A. Luini

  18. Nipple-sparing mastectomy Irradiated area A. Luini

  19. NSM + prosthesis + contralateral breast augmentation 2 weeks 5 months A. Luini

  20. Type of reconstruction Anatomic prosthesis 68% Expanders 19% Round prosthesis 5% TRAM 8% A. Luini

  21. Nipple Sparing Mastectomy Definitive prostheses 73% Immediate left reconstruction with implant A. Luini

  22. Nipple Sparing Mastectomy Expanders 19% Two-step implant reconstruction A. Luini

  23. Nipple Sparing Mastectomy TRAM 8% Immediate pedicled TRAM reconstruction A. Luini

  24. RESULTS

  25. A. Luini

  26. 1060 NSM in 1023 patients 37 bilateral( March 2002 - March 2007) infiltrating : 63% in situ : 37% despite frozen section negative… 86 final histology positive (8%) (70 in situ, 16 invasive) 43 NAC removed (local anesth.) A. Luini

  27. Complications (1060 NSM) Immediate NAC necrosis 8.8% Infections 2.0% Delayed Capsular contracture 15% Radiodystrophy 7.5% A. Luini

  28. NAC necrosis Partial 58 (5%) Total 26 (3,8%) Secondary reconstruction A.Luini

  29. NAC necrosis Spontaneous healing with a TRAM

  30. Infections • cases 2% • 42 prostheses removed 4% A.Luini

  31. Capsular contracture 157 capsulotomies 15% A. Luini

  32. nipple sparing mastectomy ELIOT (16 Gy) But … 206 cases received a delayed radiotherapy the day after surgery A. Luini

  33. Prosthesis removal p = 0.0829 A. Luini

  34. Capsular contracture p = 0.3179 A. Luini

  35. Cosmetic results minimum follow up 1 year, scale 0 - 10 Good result (score 7-10) Patient evaluation82.3% Surgeon evaluation 84.8% A. Luini

  36. NAC sensibility At one year, scale 0 - 10 score 0-3 48.0% score 4-6 32.8% score 7-10 18.8% A .Luini

  37. Fig.1 Did you find it difficult to look at your self naked?Fig.2Do you find it difficult being seen naked by your partner? Do you feel your body less whole (disabled) as a result of the surgery? Quanto si è sentita mutilata come conseguenza dell’intervento?

  38. ONCOLOGICAL RESULTS MEDIUM FOLLOW UP 20 MONTHS (RANGE 1-70) 1060 NSM in 1023 patients Invasive carcinoma 63% In situ carcinoma 37%

  39. EVENTS Local recurrence 13 (1.2%) Distant metastases 36 (3.5%) Deaths 3 (0.3%) A. Luini

  40. Local recurrences 13 cases (1.2 %) All distant from the NAC (10 tumor bed, 3 upper quadrant) A. Luini

  41. Conclusion Nipple sparing mastectomy with intraoperative radiotherapy is a safe procedure to reduce the psychological trauma due to mastectomy in selected cases A. Luini

More Related