Pregnancy Associated Breast Changes After Nipple Sparing Mastectomy
Kristine C. Paik, B.S.1, Seth Z. Aschen, MD2, Alexander S. Swistel, MD2, Mia Talmor, MD2.
1Weill Cornell Medical College, New York, NY, USA, 2Weill Cornell Medicine, New York, NY, USA.
PURPOSE: We evaluate patients of reproductive age who have undergone nipple sparing mastectomy (NSM) and implant-based reconstruction, comparing those who have become pregnant and those who have not with respect to clinical and radiologic changes reported on follow-up. Recent studies suggest that almost 40% of patients diagnosed with breast cancer, who are of reproductive age, want to have children after completing treatment. However, there is a dearth of literature evaluating outcomes for this population.
METHODS: Any patient 45 years of age or younger at the time of NSM was defined to be of reproductive age and selected for evaluation and followed prospectively. The presence or absence of breast exam changes in the setting of pregnancy after NSM were recorded.
RESULTS: 35 patients became pregnant after NSM and 159 patients did not become pregnant after NSM. Of those who became pregnant, nearly half reported some clinical change just prior to, or immediately after delivery. These included color change and discharge at the residual nipple areolar complex, and palpable nodularity elsewhere. For those with palpable changes, an ultrasound was performed and hypoechoic lesions with variable vascularity were identified. For those who went on to excision, lactational hyperplasia was the most common diagnosis.
CONCLUSION: This study aids clinicians in guiding patients who plan on becoming pregnant after NSM. Patients who became pregnant after NSM commonly had clinical breast changes, with majority found to be benign. Ultrasound is an appropriate first line investigation for changes including hyperplasia of remaining ductal and glandular tissue.
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