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.
![A164959_2_En_35_Fig2_HTML.gif](/wp-content/uploads/2016/04/A164959_2_En_35_Fig2_HTML.gif)
![A164959_2_En_35_Fig2_HTML.gif](/wp-content/uploads/2016/04/A164959_2_En_35_Fig2_HTML.gif)
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).
![A164959_2_En_35_Fig3_HTML.gif](/wp-content/uploads/2016/04/A164959_2_En_35_Fig3_HTML.gif)
![A164959_2_En_35_Fig3_HTML.gif](/wp-content/uploads/2016/04/A164959_2_En_35_Fig3_HTML.gif)
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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