Case Presentation
A Caucasian woman, aged 53, presented to the breast surgery department
with a small nodule on her left nipple, self-diagnosed 6 months prior to
her visit. The patient reported that the nodule had slightly increased
in size, had formed a traumatic surface and a mildly hemorrhagic
discharge had been produced. The patient had a negative personal and
family history for cancer, no breast cancer risk factors, no other
comorbidities or administered medications. She did not recall any trauma
on her left breast and reported no other symptoms, like itching. On
clinical examination the nodule was soft, fragile and bled easily. The
physical examination, ultrasound scan and mammography of the breasts
were negative for any associated pathology. Cytology examination of the
nipple discharge was negative for cancerous cells and scanty presence of
red cells was reported.
The hypothesis of NA was proposed and the patient was referred to a
dermatologist, who performed a punch biopsy in order to confirm the
diagnosis. Histopathology examination revealed benign nodular glandular
proliferation on the nipple area embedded in a fibrotic stroma.
Immunohistochemical evaluation using the p63 / h-caldesmon cocktail,
revealed the presence of myo-epithelial cells. Cytokeratin 5/6
identified features of usual ductal hyperplasia, whereas the estrogen
receptor expression was low. The diagnosis of nipple adenoma was
confirmed with the typical histological and immunohistochemical
features. The excision of the lesion confirmed the initial biopsy
diagnosis (Figure 1) .
The patient underwent surgical excision of the nipple adenoma under
local anesthesia. Prior to the procedure, the patient was marked twice
pre-operatively around the areola region (Figure 2) with a
distance that aimed to be similar to the protrusion of the right nipple.
The NAC of this patient had an adequate size and her breasts were rather
large. After the complete excision of the nipple, which was completely
covered with the adenoma, two purse string sutures were placed at the
remaining areola; one at the edge of the incision, and one at the
periphery, at such a distance to allow adequate projection, mimicking
the one of the right nipple. Tightening of the two sutures was applied
with caution in order to avoid any tension during healing process.(Figure 2) . The patient fully recovered with no complications
and was discharged one hour after the procedure. The patient was
inspected at 10 days and 4 months post-operatively and underwent
follow-up diagnostics every 6 months. There was minimal flattening of
the area but enough projection to mimic a nipple. The patient reported
satisfactory aesthetic result and had no intention of further aesthetic
interventions. There were no adverse and/or unanticipated events
observed. The patient signed an informed consent form according to the
institutional regulations for this publication.