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Pregnancy-Associated Breast Changes after Nipple-Sparing Mastectomy
Seth Z Aschen1, Kristine C Paik2, Alexander S Swistel3
1From the Divisions of Plastic and Reconstructive Surgery.
Plastic and Reconstructive Surgery
|February 2, 2023
Summary
Pregnancy after nipple-sparing mastectomy (NSM) can cause clinical breast changes, but these are usually benign. Ultrasound is recommended for evaluating these changes, with lactational hyperplasia being a common diagnosis.
Area of Science:
- Oncology
- Reproductive Medicine
- Plastic Surgery
Background:
- Breast cancer significantly impacts women of reproductive age, many of whom desire future fertility.
- Nipple-sparing mastectomy (NSM) followed by implant-based reconstruction is an option for these patients.
- Underrepresentation of reproductive-age women in breast cancer studies necessitates further investigation.
Purpose of the Study:
- To evaluate clinical and radiologic changes in women of reproductive age following nipple-sparing mastectomy (NSM) and subsequent pregnancy.
- To compare pregnant patients with non-pregnant patients post-NSM.
Main Methods:
- Prospective evaluation of patients aged 45 or younger undergoing NSM.
- Recording of breast examination changes in patients who became pregnant after NSM.
- Utilizing ultrasound for palpable changes and correlating findings with histopathology.
Main Results:
- 36 patients became pregnant post-NSM; 158 did not.
- Nearly 50% of pregnant patients reported clinical changes around delivery (e.g., nipple-areola discoloration, discharge, palpable nodularity).
- Ultrasound revealed hypoechoic lesions; excision confirmed lactational hyperplasia as the most frequent diagnosis.
Conclusions:
- Pregnancy after NSM frequently leads to clinical breast changes.
- Ultrasound is a suitable initial diagnostic tool for these post-NSM breast changes.
- The majority of pregnancy-associated breast changes after NSM are benign, often representing lactational hyperplasia.
