Improved sub-areolar breast tissue removal in nipple-sparing mastectomy using hydrodissection

Area of Science:

• Oncology
• Surgical Oncology
• Breast Surgery

Background:

• Nipple-sparing mastectomy (NSM) aims to preserve the nipple-areola complex (NAC).
• Tumor cells beneath the NAC can necessitate conversion to skin-sparing mastectomy (SSM).
• Accurate assessment of retro-areolar tissue is crucial for oncologic safety in NSM.

Purpose of the Study:

• To evaluate a novel hydrodissection technique for NAC dissection in NSM.
• To compare the completeness of breast tissue removal using sharp isolation versus hydrodissection followed by sharp isolation.
• To assess the impact of the technique on the rate of conversion from NSM to SSM.

Main Methods:

• A new technique involving hydrodissection of the areola prior to NAC dissection was developed.
• Two cohorts were compared: Cohort 1 (sharp isolation) and Cohort 2 (hydrodissection followed by sharp isolation).
• Histological examination of removed NACs assessed for residual breast glandular tissue.

Main Results:

• Conversion to SSM occurred in 17.4% of cases due to retro-areolar cancer.
• Histological analysis revealed residual glandular tissue in 92% of Cohort 1 cases versus 14% in Cohort 2.
• Hydrodissection facilitated NAC dissection and more complete breast tissue removal.

Conclusions:

• Hydrodissection creates a favorable subdermal plane for NAC dissection in NSM.
• This technique enhances the radicality of breast tissue removal, potentially reducing relapse risk.
• The findings are particularly relevant for breast cancer treatment and BRCA 1-2 mutation carriers.