A bilateral nipple-sparing mastectomy was done through an incision in the inframammary fold (resection volume was 330 and 340 g). Reoperation sentinel node biopsy found three negative nodes in the left axilla and two negative nodes in the right axilla. Nipple coring ensured adequate tissue resection behind the nipple region with the intraoperative frozen section examination from the retroareolar region negative (and negative in the final histology). A subpectoral pocket was created with the major pectoralis muscle being dissected off its origin in the inferior and inferomedial part of the breast. A 250 cc round implant was implanted in the submuscular pocket and covered with a slow absorbable mesh (TIGR^®, Novus Scientific, Fig. 41.2a), which was fixed to the pectoralis major muscle caudally and cranially and the serratus fascia laterally with absorbable sutures (2.0 Vicryl) (Fig 41.2b, c). One suction drain was placed subpectorally.

Final histology found scattered tumor cells in the upper inner quadrant of the left breast with a total size of 18 mm. The postoperative course was uneventful.