# Innovative technique for managing extreme relapsing bilateral pseudoangiomatous stromal hyperplasia (PASH) in a young woman: A case report highlighting a novel intervention in reconstruction

## TL;DR

A novel surgical technique using immediate implantation after mastectomy successfully managed a rare, recurrent breast condition in a young woman with excellent cosmetic results and no recurrence.

## Contribution

A novel surgical technique combining mastectomy with immediate prepectoral implantation is proposed for managing large, recurrent PASH.

## Key findings

- The novel technique achieved complication-free reconstruction with no recurrence after 18 months.
- Immediate implantation after mastectomy offers prompt restoration of breast shape with fewer surgeries.
- The approach is promising for selected cases of large, relapsing bilateral benign breast diseases.

## Abstract

Pseudoangiomatous stromal hyperplasia (PASH) is a rare breast stromal lesion that typically manifests clinically as a palpable unilateral, painless lump that is freely movable and has a rubbery or firm consistency. The diagnosis can be confirmed by a core needle biopsy (CNB) or surgical excision. Treatment options include medical treatment with hormonal management for asymptomatic patients or local excision and breast reduction in rare cases.

We reported the case of a 24-year-old woman with a history of taking contraceptive pills for about a year. Examination revealed extremely enlarged, sore, and swollen breasts, particularly the right side, marking her third PASH relapse. The patient underwent a surgical skin-reducing mastectomy (SRM) using a novel technique with an immediate prepectoral implant covered by a dermal flap to reconstruct the breast shape due to the large PASH lesions and aiming for optimal cosmetic outcomes. The procedure was complication-free with no recurrence after 18 months of follow-up.

Mastectomy followed by immediate implantation offers benefits such as prompt restoration of breast shape with fewer surgeries.

This case report highlights the successful use of immediate implantation in reconstructing large recurrent benign breast diseases. The outcomes indicate that immediate implantation shows promise as a suitable choice for carefully selected patients managing large, relapsing bilateral benign breast diseases. However, due to common complications such as infection and implant loss, it is not generally recommended for benign lesions. The decision should be made on a case-by-case basis, considering the size, recurrence, and individual suitability.

•PASH typically grows slowly, instances of rapid growth are rare.•Symptomatic and recurrent cases can benefit from surgical interventions such as breast reduction.•SRM improves aesthetic outcomes and psychological well-being.•Mastectomy with immediate reconstruction is promising for managing recurrent huge PASH.

PASH typically grows slowly, instances of rapid growth are rare.

Symptomatic and recurrent cases can benefit from surgical interventions such as breast reduction.

SRM improves aesthetic outcomes and psychological well-being.

Mastectomy with immediate reconstruction is promising for managing recurrent huge PASH.