Breast cancer in pregnancy: concurrent cesarean section, nipple-sparing mastectomy, and immediate breast reconstruction—case report
BackgroundPregnancy-associated breast cancer (PABC), with an incidence rate from 1:3,000 to 1:10,000 deliveries, is the most frequent cancer during pregnancy. PABC appropriate management must take into consideration both the maternal oncological safety and the fetal health, thus posing a challenge f...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2024-01-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2023.1332862/full |
| _version_ | 1797362386059919360 |
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| author | Alessandro Innocenti Pietro Susini Luca Grimaldi Tommaso Susini |
| author_facet | Alessandro Innocenti Pietro Susini Luca Grimaldi Tommaso Susini |
| author_sort | Alessandro Innocenti |
| collection | DOAJ |
| description | BackgroundPregnancy-associated breast cancer (PABC), with an incidence rate from 1:3,000 to 1:10,000 deliveries, is the most frequent cancer during pregnancy. PABC appropriate management must take into consideration both the maternal oncological safety and the fetal health, thus posing a challenge for the mother, the baby, and the clinicians. The treatment should adhere as closely as possible to the breast cancer (BC) guidelines. Therefore, surgery is a mainstay, and, when mastectomy is required, breast reconstruction (BR) is a topic of debate. To minimize the risks to the baby, most surgeons postpone BR to delivery. However, a delayed breast reconstruction (DBR) could affect the outcome. In the present case, we report cesarean section concurrent with mastectomy and immediate breast reconstruction (IBR).MethodsA 37-year-old patient, at the 36th week of pregnancy with PABC, underwent simultaneous cesarean delivery, nipple-sparing mastectomy, and IBR. To minimize risks for the newborn, cesarean was firstly performed under spinal anesthesia. Immediately after, breast surgery, including mastectomy and IBR, was performed under general anesthesia. Partial submuscular IBR with an acellular porcine dermal matrix concluded the surgical procedure. Lactation was inhibited, and adjuvant chemotherapy and hormone therapy were administered to the patient.ResultsIn a single surgical session, cesarean delivery, subcutaneous mastectomy, axillary dissection, and IBR were successfully carried out. No early or late postoperative complications were reported for both the patient and the newborn. Histopathological investigation reported a multifocal and multicentric infiltrating ductal carcinoma. After a 6-year follow-up, the patient is alive and well.ConclusionTo the best of our knowledge, this is the first reported case of concomitant cesarean delivery, PABC mastectomy, axillary dissection, and IBR. This surgical strategy allowed PABC treatment by the BC guideline, minimizing the newborn’s disadvantage and permitting, at the same time, the best final BR outcome. |
| first_indexed | 2024-03-08T16:07:18Z |
| format | Article |
| id | doaj.art-45c26d49e73a475b9878b3b352ae63a4 |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-03-08T16:07:18Z |
| publishDate | 2024-01-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-45c26d49e73a475b9878b3b352ae63a42024-01-08T05:04:39ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2024-01-011310.3389/fonc.2023.13328621332862Breast cancer in pregnancy: concurrent cesarean section, nipple-sparing mastectomy, and immediate breast reconstruction—case reportAlessandro Innocenti0Pietro Susini1Luca Grimaldi2Tommaso Susini3Plastic and Reconstructive Microsurgery, Careggi University Hospital, Florence, ItalyPlastic Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, ItalyPlastic Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, ItalyBreast Unit, Gynecology Section, Department of Health Sciences, University of Florence, Florence, ItalyBackgroundPregnancy-associated breast cancer (PABC), with an incidence rate from 1:3,000 to 1:10,000 deliveries, is the most frequent cancer during pregnancy. PABC appropriate management must take into consideration both the maternal oncological safety and the fetal health, thus posing a challenge for the mother, the baby, and the clinicians. The treatment should adhere as closely as possible to the breast cancer (BC) guidelines. Therefore, surgery is a mainstay, and, when mastectomy is required, breast reconstruction (BR) is a topic of debate. To minimize the risks to the baby, most surgeons postpone BR to delivery. However, a delayed breast reconstruction (DBR) could affect the outcome. In the present case, we report cesarean section concurrent with mastectomy and immediate breast reconstruction (IBR).MethodsA 37-year-old patient, at the 36th week of pregnancy with PABC, underwent simultaneous cesarean delivery, nipple-sparing mastectomy, and IBR. To minimize risks for the newborn, cesarean was firstly performed under spinal anesthesia. Immediately after, breast surgery, including mastectomy and IBR, was performed under general anesthesia. Partial submuscular IBR with an acellular porcine dermal matrix concluded the surgical procedure. Lactation was inhibited, and adjuvant chemotherapy and hormone therapy were administered to the patient.ResultsIn a single surgical session, cesarean delivery, subcutaneous mastectomy, axillary dissection, and IBR were successfully carried out. No early or late postoperative complications were reported for both the patient and the newborn. Histopathological investigation reported a multifocal and multicentric infiltrating ductal carcinoma. After a 6-year follow-up, the patient is alive and well.ConclusionTo the best of our knowledge, this is the first reported case of concomitant cesarean delivery, PABC mastectomy, axillary dissection, and IBR. This surgical strategy allowed PABC treatment by the BC guideline, minimizing the newborn’s disadvantage and permitting, at the same time, the best final BR outcome.https://www.frontiersin.org/articles/10.3389/fonc.2023.1332862/fullpregnancy-associated breast cancerbreast cancernipple-sparing mastectomyimmediate breast reconstructioncase report |
| spellingShingle | Alessandro Innocenti Pietro Susini Luca Grimaldi Tommaso Susini Breast cancer in pregnancy: concurrent cesarean section, nipple-sparing mastectomy, and immediate breast reconstruction—case report Frontiers in Oncology pregnancy-associated breast cancer breast cancer nipple-sparing mastectomy immediate breast reconstruction case report |
| title | Breast cancer in pregnancy: concurrent cesarean section, nipple-sparing mastectomy, and immediate breast reconstruction—case report |
| title_full | Breast cancer in pregnancy: concurrent cesarean section, nipple-sparing mastectomy, and immediate breast reconstruction—case report |
| title_fullStr | Breast cancer in pregnancy: concurrent cesarean section, nipple-sparing mastectomy, and immediate breast reconstruction—case report |
| title_full_unstemmed | Breast cancer in pregnancy: concurrent cesarean section, nipple-sparing mastectomy, and immediate breast reconstruction—case report |
| title_short | Breast cancer in pregnancy: concurrent cesarean section, nipple-sparing mastectomy, and immediate breast reconstruction—case report |
| title_sort | breast cancer in pregnancy concurrent cesarean section nipple sparing mastectomy and immediate breast reconstruction case report |
| topic | pregnancy-associated breast cancer breast cancer nipple-sparing mastectomy immediate breast reconstruction case report |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2023.1332862/full |
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