Nipple-sparing mastectomy was done using an incision in the inframammary fold. Nipple coring was performed, and retroareolar biopsy found no tumor in the frozen section (as well as in the permanent histology). A subpectoral pocket was created in a dual plane fashion and a 285 cc anatomical implant was inserted and covered laterally with an acellular dermal matrix (ADM), which was sutured to the lateral border of the pectoralis major muscle and the fascia of the serratus anterior muscle. One drain was placed subpectorally, another one in the mastectomy pocket. Sentinel node biopsy performed through an axillary incision found one macrometastatic sentinel node and axillary dissection was done.

A supportive bra with a superior pole strap was worn postoperatively for 8 weeks. The suction drains were removed with the drainage less than 20 cc for 24 h. The postoperative course was uneventful.

The final histology found a multifocal cancer with a total tumor size of 55 mm (pT3, high grade, receptor positive, Her-2-neu negative, Ki 67 20 %) composed of the three invasive masses and with invasive cancer cells in between them. Out of 17 removed lymph nodes, two showed macrometastases. Due to the tumor biology and the young age of the patient, adjuvant chemotherapy was suggested. Although a mastectomy was done, radiotherapy to the thoracic wall and the supraclavicular nodes was suggested, which was due to the tumor size and the two positive lymph nodes. Radiation was given to the thoracic wall; the patient declined radiation to the supraclavicular nodes. Endocrine treatment with tamoxifen was suggested for 5 years after completion of chemotherapy.