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Title: A anatomical study of the skin, nipple and areola of the breast
Author: Rusby , Jennifer E.
Awarding Body: University of Oxford
Current Institution: University of Oxford
Date of Award: 2009
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Background: Although effective local control of breast cancer is the primary goal of surgery, the long term aesthetic outcome is also important. Nipple-sparing mastectomy aims to address this but there is no consensus on its clinical application. The aim of this thesis is to provide a scientific basis for nipple-sparing mastectomy. Methods: Data were derived from a consecutive series of patients who underwent nipple-sacrificing mastectomy. The anatomical work used histological coronal sections through nipple specimens and three-dimensional reconstructions produced from serial sections. Ductal, vascular and smooth muscle anatomy of the nipple and features of the anatomy of the skin were investigated. Anatomical findings were applied to evaluate surgical and pathological approaches. Results: The incidence of occult nipple involvement in a series of women undergoing therapeutic skin-sparing mastectomy (and therefore potentially eligible for nipplesparing) was 21 %. Nipple involvement was associated with larger tumour diameter and smaller distance from the nipple on multivariate analysis. A predictive model was developed. The median number of ducts in a cross section through the nipple papilla was 23. Three dimensional reconstruction of duct anatomy shows a regular pattern of ducts, several of which may originate from common orifice on the nipple surface. Some ducts do originate on the areola rather than the nipple tip. The central duct bundle narrows to fonn a waist. The average duct diameter at the tip was O.06mm. In a three-dimensional reconstruction of the nipple, blood supply appears to arrive both via deep vessels and a more superficial supply. Small vessels are distributed throughout the nipple cross section. Ex vivo experiments demonstrated opportunities for modification of surgical and pathological technique. Conclusions: This work adds to current knowledge about nipple-sparing mastectomy_ In the therapeutic setting, the risk of occult involvement of the nipple can be predicted. Anatomical findings delineating duct - vascular inter-relationships help inform decisions about surgical technique.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available