Single axillary incision reverse-sequence endoscopic nipple/skin-sparing mastectomy for giant IDP of the breast: a case report

Single axillary incision reverse-sequence endoscopic nipple/skin-sparing mastectomy for giant IDP of the breast: a case report | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL This is a preprint and has not been peer reviewed. Data may be preliminary. 9 March 2025 V1 Latest version Share on Single axillary incision reverse-sequence endoscopic nipple/skin-sparing mastectomy for giant IDP of the breast: a case report Authors : Mingfang Jiang , Yushan Mao 0000-0002-5539-8832 , Chuheng Zhou , Xia Chen , and Lingling Zhao [email protected] Authors Info & Affiliations https://doi.org/10.22541/au.174149642.23964944/v1 220 views 93 downloads Contents Abstract Supplementary Material Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Background Intraductal papilloma (IDP) is a benign lesion, rarely exceeding 10 cm in diameter, which may be associated with carcinoma in situ or invasive carcinoma components, leading to difficult diagnostic imaging or puncture biopsy pathology. Case We describe the case of a middle-aged woman with a giant IDP of the breast Single axillary incision reverse-sequence endoscopic nipple/skin-sparing mastectomy for giant IDP of the breast: a case report Mingfang Jiang 1 , Yushan Mao 2 , Chuheng Zhou 3 ,Xia Chen 1 , Lingling Zhao 1 1 Sichuan Science City Hospital, Mianyang, Sichuan 2 Chengdu Second People’s Hospital, Chengdu, Sichuan 3 Cancer Hospital, Mianyang, Sichuan Corresponding Author:Lingling Zhao First and last name:Zhao Lingling E-mail addresses: [email protected] Keywords: Intraductal papilloma Single axillary incision reverse-sequence endoscopic retention, Pathological diagnosis Introduction Intraductal papilloma (IDP) is a benign lesion, rarely exceeding 10 cm in diameter, which may be associated with carcinoma in situ or invasive carcinoma components, leading to difficult diagnostic imaging or puncture biopsy pathology(1,2). We describe the case of a middle-aged woman with a giant IDP of the breast with focal carcinoma who underwent a new technique-single axillary incision reverse-sequence endoscopic salvage resection(3,4). A review of magnetic resonance imaging, diagnostic evaluation and pathologic correlation, as well as relevant surgical approaches, is documented. Clinical practice should be alert to the possibility that giant IDP may contain a malignant component, and when excision of a giant breast mass is required, a single axillary incision with reverse-sequence endoscopic preservation of excision can provide the patient’s post-excision breast aesthetic needs through breast reconstruction techniques. Case History A left breast lump was found in a 43-year-old woman 1 year ago. 2 months ago, the lump grew rapidly and there was a bloody discharge from the left nipple with occasional localized pain. No relevant medical history or previous breast trauma was found, and there was no family history of breast cancer. Physical examination revealed a left breast mass about 15 cm in diameter, mainly involving the outer upper quadrant of the breast, with a bluish-purple coloration of the overlying skin portion, and an outward-superior deviation and deformation of the left breast (Figure 1). Differential diagnosis, investigations and treatment Laboratory tests showed elevated tumor marker CEA 23.196ng/ml. MRI of both breasts showed that the volume of the left breast had increased, and a huge irregular cystic solid mass was seen in it, measuring about 85*91*102mm, with a discernible border, the solid component was mainly located in the posterior-superior portion of the nipple, and the margins were lobulated and cauliflower-like (Figure 2), and the imaging features suggested the possibility of malignant tumors. To clarify the diagnosis, pathologic examination of the left breast mass and left axillary lymph node puncture was performed. The results of axillary lymph node examination showed lymphoid hyperplasia. Examination of the breast mass showed ductal epithelial hyperplasia with papillary hyperplasia in the focal area. Further immunohistochemistry was performed which showed IDP with ductal epithelial common type hyperplasia. (Figure 3) The patient had a strong aesthetic demand, and considering the possibility of malignancy on preoperative imaging, the patient’s consent was sought and the patient was finally treated with a trans left axillary lumpectomy with a reverse sequence method of subcutaneous resection of the left mammary gland and anterior pectoralis muscle prosthesis combined with a patch for stage I reconstruction and biopsy of the left anterior sentinel lymph node. The surgical procedure was as follows: through an invisible axillary incision in reverse anatomical order (posterior breast space-subcutaneous), the breast gland was excised, and a suitable prosthesis and biopatch were selected and placed in front of the pectoralis major muscle,and intraoperative sentinel lymph node biopsy of 3 nodes was performed on frozen section for rapid pathological examination, which showed no neoplastic lesions. Conclusion IDP is a benign, or noncancerous breast tumor, most IDPs are small, with a few lesions exceeding 5 centimeters in diameter, and IDPs greater than 10 centimeters are more rare (12,13). Papilloma diagnosed on imaging or gross needle aspiration biopsy may be diagnosed as atypical ductal growths, carcinoma in situ, and invasive carcinoma after surgical resection (14). The use of a single axillary incision for reverse-sequence endoscopic retention mastectomy gives patients access to their therapeutic and aesthetic needs by overcoming the limitations of traditional endoscopic retention mastectomy applications. Results The post-operative breast tissue underwent pathologic examination with findings of IDP with ductal epithelial exuberant hyperplasia and focal areas of atypical hyperplasia, and low-grade ductal carcinoma in situ formation (Figure 4). Post-operative diagnosis is giant IDP with localized intraductal carcinoma of the left breast (Tis Luminal B type). The patient had a good postoperative recovery, with no signs of tumor recurrence and satisfactory appearance at 1-year follow-up (Figure 5), and was treated with post-operative endocrine therapy, tamoxifen 10mg bid. Discussion IDP lesions of the breast including with or without atypical ductal hyperplasia, IDPs with carcinoma in situ or invasive carcinoma, carcinoma in situ or invasive carcinoma, pericytes carcinoma, and solid carcinoma (5,6). IDP is the most common symptom in patients with IDP, but patients usually do not have specific clinical findings before imaging, and puncture pathology testing is often inconclusive due to limited access to material, and may diagnose a benign lesion that is inadequately treated or requires a second surgical procedure (7,8,9). Single axillary incision reverse-sequence endoscopic retention resection is a safe, cheaper, and efficient surgical technique with a reliable mid-term oncologic safety profile. In suitable candidates, breast reconstruction techniques based on subpectoral implants can provide excellent cosmetic results (10,11). In our patients, transaxillary mastectomy of the breast mass was performed due to a large mass in the breast and the need for breast aesthetics. According to us, only a few cases have been reported of giant IDP of the breast with focal carcinoma and new technique-single axillary incision reverse sequence endoscopic retention resection cases. Conflict of Interest Statement The authors have no relevant financial or nonfinancial interests to disclose. Key Clinical Message Giant Intraductal papilloma (IDP) may contain a malignant component, and when excision of a giant IDP is required, a single axillary incision with reverse-sequence endoscopic preservation of excision can provide the patient’s post-excision breast aesthetic needs through breast reconstruction techniques. References 1. Cheah SD, Imi Sairi AH. Large breast lump with bloody nipple discharge: benign IDP. BMJ Case Rep. 2020 Nov 4;13(11):e236818. 2. Wang S, Lou J. A case of giant complicated IDP of breast on MRI and literature review. Cancer Rep (Hoboken). 2018 Dec;1(4):e1136. 3. Yang H, Liang F, Xie Y, Qiu M, Du Z. Single axillary incision reverse-order endoscopic nipple/skin-sparing mastectomy followed by subpectoral implant-based breast reconstruction: Technique, clinical outcomes, and aesthetic results from 88 preliminary procedures. Surgery. 2023 Sep;174(3):464-472. 4. Zhang S, Xie Y, Liang F, Wang Y, Wen N, Zhou J, Feng Y, Liu X, Lv Q, Du Z. Video-assisted Transaxillary Nipple-sparing Mastectomy and Immediate Implant-based Breast Reconstruction: A Novel and Promising Method. Aesthetic Plast Surg. 2022 Feb;46(1):91-98. 5. Li X, Wang H, Sun Z, Fan C, Jin F, Mao X. A retrospective observational study of intraductal breast papilloma and its coexisting lesions: A real-world experience. Cancer Med. 2020 Oct;9(20):7751-7762. 6. Li A, Kirk L. Intraductal Papilloma. 2022 Sep 26. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. 7. Pareja F, Corben AD, Brennan SB, Murray MP, Bowser ZL, Jakate K, Sebastiano C, Morrow M, Morris EA, Brogi E. Breast IDPs without atypia in radiologic-pathologic concordant core-needle biopsies: Rate of upgrade to carcinoma at excision. Cancer. 2016 Sep 15;122(18):2819-27. 8. Jaffer S, Nagi C, Bleiweiss IJ. Excision is indicated for IDP of the breast diagnosed on core needle biopsy. Cancer. 2009 Jul 1;115(13):2837-43. 9. Lewis JT, Hartmann LC, Vierkant RA, Maloney SD, Shane Pankratz V, Allers TM, Frost MH, Visscher DW. An analysis of breast cancer risk in women with single, multiple, and atypical papilloma. Am J Surg Pathol. 2006 Jun;30(6):665-72. 10. Chicco M, Ahmadi AR, Cheng HT. Systematic Review and Meta-Analysis of Complications Following Mastectomy and Prosthetic Reconstruction in Patients With and Without Prior Breast Augmentation. Aesthet Surg J. 2021 Jun 14;41(7):NP763-NP770. 11. Rinker B. A Comparison of Methods to Assess Mastectomy Flap Viability in Skin-Sparing Mastectomy and Immediate Reconstruction: A Prospective Cohort Study. Plast Reconstr Surg. 2016 Feb;137(2):395-401. 12. Kavolius J, Matsumoto C, Greatorex P, Petermann G. Case of the Month. Giant multiple IDP of the breast: a case report and review of the literature. Hawaii Med J. 2001 Mar;60(3):60-2. 13. Fatemi Y, Hurley R, Grant C, Henrichsen T, Chen B, Ghosh K. Challenges in the management of giant intraductal breast papilloma. Clin Case Rep. 2015 Jan;3(1):7-10. 14. Wu D, Shi AP, Song AL, Fan ZM; Chinese Society of Breast Surgery. Clinical practice guidelines for IDP: Chinese Society of breast surgery (CSBrS) practice guidelines 2021. Chin Med J (Engl). 2021 May 19;134(14):1658-1660. Author Contributions Lingling Zhao and Xia Chen : substantial contributions to the con- ception and design of the work, analysis and interpretation of data for the work, and drafting the work, final approval of the version to be published, and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or in- tegrity of any part of the work are appropriately investigated and resolved. Mingfang Jiang and Yushan Mao : substantial contributions to the acqui- sition, analysis and interpretation of data for the work, and revis- ing the work critically for important intellectual content, final ap- proval of the version to be published, and agreement to be account- able for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Chuheng Zhou : substantial contributions to the analysis and interpretation of data for the work and revising the work critically for important intellectual content, final approval of the version to be published, and agreement to be accountable for all aspects of the work in ensuring that questions related to the ac- curacy or integrity of any part of the work are appropriately investigated and resolved. Supplementary Material File (figure.docx) Download 948.18 KB Information & Authors Information Version history V1 Version 1 09 March 2025 Copyright This work is licensed under a Non Exclusive No Reuse License. Keywords oncology pathology and laboratory medicine surgery Authors Affiliations Mingfang Jiang Sichuan Science City Hospital View all articles by this author Yushan Mao 0000-0002-5539-8832 Chengdu Second People's Hospital View all articles by this author Chuheng Zhou Cancer Hospital View all articles by this author Xia Chen Sichuan Science City Hospital View all articles by this author Lingling Zhao [email protected] Sichuan Science City Hospital View all articles by this author Metrics & Citations Metrics Article Usage 220 views 93 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Mingfang Jiang, Yushan Mao, Chuheng Zhou, et al. Single axillary incision reverse-sequence endoscopic nipple/skin-sparing mastectomy for giant IDP of the breast: a case report. Authorea . 09 March 2025. 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