Skin-sparing mastectomy with an elliptical horizontal incision was performed with a resection specimen weight of 530 g. Sentinel lymph node biopsy found a macrometastatic and a micrometastatic sentinel node out of three removed nodes, and a level I and II axillary dissection was done. For immediate reconstruction, a 375 cc round moderate implant was inserted submuscular under the pectoralis major muscle and the serratus anterior muscle. The insertions of the pectoralis major muscle were dissected in the inframammary fold down to the fascia of the rectus abdominis muscle creating a dual plane in the inferior breast pole. Two drains were used.

The initial postoperative course was uneventful. Final histology found the 30 mm invasive cancer as described in the mammogram but additionally revealed two small invasive ductal cancers of 3 and 4 mm resulting in a total tumor size of 55 mm (the whole tumor area was measured) and 2 macrometastatic and 1 micrometastatic lymph nodes out of 22 removed nodes.

Postoperative chemotherapy and trastuzumab (for 1 year) were suggested. The postoperative result after completion of chemotherapy showed a good cosmetic result (Fig. 60.2a, b).