Central Quadrantectomy and Reconstruction of the Nipple-Areola Complex with a De-epithelialized Inferior-Based Pedicle with a Skin Island

Fig. 35.1

(a–c) Preoperative view. The 62-year-old patient had a Paget carcinoma of the nipple and intraductal carcinoma in situ of the left breast. Central quadrantectomy was planned using an inferior pedicle reduction mammoplasty with a skin island for reconstruction of the NAC

35.2 Surgery

Central quadrantectomy was performed as part of an inferior-based pedicle reduction mammoplasty with a resection volume of 1,150 g. The inferior pedicle was de-epithelialized except a small skin island, which was used for reconstruction of the NAC (Fig. 35.2a, b). Sentinel node biopsy found one negative sentinel node.

Fig. 35.2

(a, b) Intraoperative view. Following central quadrantectomy, the inferior pedicle was de-epithelialized leaving a skin island for reconstruction of the nipple

35.3 Clinical and Cosmetic Outcome

The postoperative course was uneventful. Permanent histology found a Paget carcinoma of the nipple and a 30 mm carcinoma in situ of high grade with wide clear margins of more than 5 cm. No postoperative radiation was suggested by the tumor board due to the wide resection margins.

Nine months after surgery, reconstruction of the NAC and a contralateral reduction with an inferior-based pedicle were done (Fig 35.3a, b).

Fig. 35.3

(a, b) Postoperative view. The nipple was reconstructed with a star flap technique; an inferior-based pedicle reduction mammoplasty was performed for symmetrization (a). (b) Postoperative result after 4 years

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