Complete excision of the nipple core combined with inverted nipple correction: a novel surgical intervention for reducing recurrence in Zuska's disease.

Background: Zuska's disease, a rare chronic inflammatory condition of the subareolar breast tissue, is characterized by recurrent non-puerperal abscesses and lactiferous duct fistulas. This condition poses significant therapeutic challenges because of its high recurrence rates. This study aimed to assess the effectiveness of a novel surgical approach integrating complete nipple core excision and inverted nipple correction in decreasing recurrence rates among patients with Zuska's disease, in comparison with conventional treatments. Methods: A retrospective analysis was performed on 109 patients diagnosed with Zuska's disease at the Maternal and Child Health Hospital of Hubei Province from January 2008 to December 2022. The inclusion criteria were non-lactating females with nipple inversion, pathological verification of squamous metaplasia, and comprehensive follow-up data. All patients underwent an arcuate periareolar incision, complete excision of subareolar ducts, correction of nipple inversion through purse-string suturing, and postoperative administration of bromocriptine for hyperprolactinemia. Follow-up evaluations encompassed wound healing, correction of nipple inversion, and recurrence at 1, 6, 12, 24, and 36 months. Results: The median age of the patients was 23 years (range: 13-54 years), and there were 79 nulliparous females. The mean duration of the surgery was 42±15 minutes, accompanied by blood loss (8.7±3.6 mL). No postoperative infections were detected. At a median follow-up period of 24 months (range: 18-36 months), only one case of recurrence (1%) was observed. In patients with a history of prior surgeries (33/109), the preoperative recurrence rates were significantly decreased after the surgery. In 94% of the patients, the cosmetic outcomes were evaluated as excellent/good (73 patients scored 91-100; 29 patients scored 80-90). Postoperative bromocriptine therapy normalized the prolactin levels in 37 patients with hyperprolactinemia. Conclusions: This comprehensive surgical approach effectively resolves ductal epithelial hyperplasia and anatomical malformations, attaining a 99% disease-free survival rate. In comparison with traditional methods, it yields superior aesthetic outcomes. The low recurrence rate and negligible complications substantiate its implementation as a standard treatment for Zuska's disease. Additional multicenter trials are necessary to verify the long-term efficacy.