A J mammoplasty was planned; the preoperative markings are seen in Fig. 17.1b, c. The patient underwent a wide local excision of the tumor and both the medial and lateral pedicles mobilized to allow adequate closure. Lymph node status was positive and an axillary dissection was performed.

Final histology found an invasive ductal receptor positive carcinoma of 52 mm (pT3), with 6 of 11 removed lymph nodes involved (HER2-neu negative, Ki-67 10 %). Postoperative radiation, chemotherapy, and endocrine treatment were suggested.