Breast Conservation Surgery with Inferior Pedicle Reduction Mammoplasty Followed by Skin-Sparing Mastectomy and Immediate Implant Reconstruction

Fig. 47.1

(a–c) Preoperative view and preoperative drawings for bilateral reduction mammoplasty. The 28-year-old patient underwent neoadjuvant chemotherapy for cancer in the upper outer quadrant of the left breast and had a complete clinical and radiological remission. The breast was of large size and ptotic. The location of the tumor prior to chemotherapy is outlined on the skin

47.2 Surgery

Oncoplastic breast reduction using an inferior-based pedicle was performed with concomitant reduction of the right breast. Reoperation sentinel node biopsy showed a negative sentinel node and no further axillary lymph node dissection was done.

Final histology found a pathological complete remission (yT0yN0). The postoperative course was uneventful; radiation of the left breast was suggested. The postoperative result after 8 weeks was rated as excellent (Fig. 47.2a–c).

Fig. 47.2

(a–c) Excellent postoperative result 8 weeks after bilateral reduction mammoplasty with an inferior pedicle. Due to BCA 1 mutation, a bilateral nipple-sparing mastectomy was planned with immediate implant reconstruction. The position of the mesh is outlined on the skin

47.3 Clinical and Cosmetic Outcome

Genetic testing for BRCA 1 and 2 mutations was done 2 years prior to the diagnosis of the cancer and showed a negative result. Eight weeks after surgery, the patient received a supplementary report with one of the “unknown variants” now thought to be associated with an increased risk for breast cancer. The new findings were discussed with the patient and she decided to undergo prophylactic bilateral mastectomy with preservation of the nipple-areola complex (NAC) and immediate reconstruction with implants.

Surgery was planned as nipple-sparing mammoplasty using the previous incisions for reduction mammoplasty with the inferior pedicle preserved as a de-epithelialized thin pedicle just to ensure blood supply of the NAC. Intraoperatively we found that preserving the NAC on the inferior pedicle would have left too much breast tissue behind and would not constitute a prophylactic mastectomy. Therefore, the NAC was resected together with the inferior pedicle through a horizontal elliptical incision. The pectoralis major muscle was completely released from its insertions in the inframammary fold. A 330 cc anatomical implant was inserted subpectorally and covered with a large extralight TiLOOP Bra^®

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