Persistent nipple discharge after nipple-sparing mastectomy secondary to unincorporated AlloDerm: a case report
Abstract Background Rates of nipple-sparing mastectomies have increased over the past decade. In 2017, acellular dermal matrix was used in 56% of breast reconstructive procedures, with complication rates similar to operations without AlloDerm. Although persistent nipple discharge after nipple-sparin...
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doaj-b2439570ae5f457fb4d75f08e08143612020-11-25T03:23:49ZengBMCJournal of Medical Case Reports1752-19472020-09-011411510.1186/s13256-020-02476-9Persistent nipple discharge after nipple-sparing mastectomy secondary to unincorporated AlloDerm: a case reportAvra S. Laarakker0Audrey Rich1Jeffrey Wu2Stephanie Fine3Division of Plastic, Reconstructive and Burn Surgery, MSC10 5610, 1 University of New MexicoUniversity of New Mexico School of MedicineDivision of Plastic, Reconstructive and Burn Surgery, MSC10 5610, 1 University of New MexicoDivision of Surgical Oncology, University of New MexicoAbstract Background Rates of nipple-sparing mastectomies have increased over the past decade. In 2017, acellular dermal matrix was used in 56% of breast reconstructive procedures, with complication rates similar to operations without AlloDerm. Although persistent nipple discharge after nipple-sparing mastectomy is a rare event, it has been described in the literature. Other authors have described evaluation and treatment on a case-by-case basis. To the best of our knowledge, this is the first case report to describe a persistent unilateral discharge after multiple operative revisions and to provide an algorithmic approach to workup and treatment. Case presentation We present a case of a 29-year-old Hispanic woman with BRCA1 mutation who underwent a prophylactic bilateral nipple-sparing mastectomy with immediate reconstruction using AlloDerm. The year following her operation, the patient underwent two surgical revisions, one for implant rippling and one for asymmetry. Six months after her second revision, she presented to our hospital with a capsular contracture and unilateral clear nipple discharge. Her breast ultrasound showed dilated subareolar ducts and a suspicious mass. Magnetic resonance imaging identified a benign-appearing, rim-enhancing fluid collection. She underwent a third revision. One year later, she returned to our clinic with bloody nipple discharge, erythematous skin changes, and a palpable breast lump. Her surgical biopsy showed a fold in AlloDerm and chronic inflammatory changes. She continued experiencing discharge and opted for nipple excision. During the operation, a lacrimal probe demonstrated a direct connection between the discharging external duct and a seroma associated with an area of unincorporated AlloDerm. The section of unincorporated AlloDerm was excised, and no evidence of malignancy was identified. Ten months later, the patient remained symptom-free and had progressed to placement of final silicone implants. Conclusions To the best of our knowledge, this is the first case report to describe a nongravid patient with persistent unilateral sanguineous nipple discharge after multiple operative revisions. A visible communication between the draining duct and a seroma associated with unincorporated AlloDerm was ultimately identified. We present a clinical algorithm for patients with nipple discharge after nipple-sparing mastectomy.http://link.springer.com/article/10.1186/s13256-020-02476-9Nipple dischargeNipple-sparing mastectomySeromaAlloDermUnincorporated AlloDermCase report |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Avra S. Laarakker Audrey Rich Jeffrey Wu Stephanie Fine |
spellingShingle |
Avra S. Laarakker Audrey Rich Jeffrey Wu Stephanie Fine Persistent nipple discharge after nipple-sparing mastectomy secondary to unincorporated AlloDerm: a case report Journal of Medical Case Reports Nipple discharge Nipple-sparing mastectomy Seroma AlloDerm Unincorporated AlloDerm Case report |
author_facet |
Avra S. Laarakker Audrey Rich Jeffrey Wu Stephanie Fine |
author_sort |
Avra S. Laarakker |
title |
Persistent nipple discharge after nipple-sparing mastectomy secondary to unincorporated AlloDerm: a case report |
title_short |
Persistent nipple discharge after nipple-sparing mastectomy secondary to unincorporated AlloDerm: a case report |
title_full |
Persistent nipple discharge after nipple-sparing mastectomy secondary to unincorporated AlloDerm: a case report |
title_fullStr |
Persistent nipple discharge after nipple-sparing mastectomy secondary to unincorporated AlloDerm: a case report |
title_full_unstemmed |
Persistent nipple discharge after nipple-sparing mastectomy secondary to unincorporated AlloDerm: a case report |
title_sort |
persistent nipple discharge after nipple-sparing mastectomy secondary to unincorporated alloderm: a case report |
publisher |
BMC |
series |
Journal of Medical Case Reports |
issn |
1752-1947 |
publishDate |
2020-09-01 |
description |
Abstract Background Rates of nipple-sparing mastectomies have increased over the past decade. In 2017, acellular dermal matrix was used in 56% of breast reconstructive procedures, with complication rates similar to operations without AlloDerm. Although persistent nipple discharge after nipple-sparing mastectomy is a rare event, it has been described in the literature. Other authors have described evaluation and treatment on a case-by-case basis. To the best of our knowledge, this is the first case report to describe a persistent unilateral discharge after multiple operative revisions and to provide an algorithmic approach to workup and treatment. Case presentation We present a case of a 29-year-old Hispanic woman with BRCA1 mutation who underwent a prophylactic bilateral nipple-sparing mastectomy with immediate reconstruction using AlloDerm. The year following her operation, the patient underwent two surgical revisions, one for implant rippling and one for asymmetry. Six months after her second revision, she presented to our hospital with a capsular contracture and unilateral clear nipple discharge. Her breast ultrasound showed dilated subareolar ducts and a suspicious mass. Magnetic resonance imaging identified a benign-appearing, rim-enhancing fluid collection. She underwent a third revision. One year later, she returned to our clinic with bloody nipple discharge, erythematous skin changes, and a palpable breast lump. Her surgical biopsy showed a fold in AlloDerm and chronic inflammatory changes. She continued experiencing discharge and opted for nipple excision. During the operation, a lacrimal probe demonstrated a direct connection between the discharging external duct and a seroma associated with an area of unincorporated AlloDerm. The section of unincorporated AlloDerm was excised, and no evidence of malignancy was identified. Ten months later, the patient remained symptom-free and had progressed to placement of final silicone implants. Conclusions To the best of our knowledge, this is the first case report to describe a nongravid patient with persistent unilateral sanguineous nipple discharge after multiple operative revisions. A visible communication between the draining duct and a seroma associated with unincorporated AlloDerm was ultimately identified. We present a clinical algorithm for patients with nipple discharge after nipple-sparing mastectomy. |
topic |
Nipple discharge Nipple-sparing mastectomy Seroma AlloDerm Unincorporated AlloDerm Case report |
url |
http://link.springer.com/article/10.1186/s13256-020-02476-9 |
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