Tumor quadrantectomy (with resection of the skin over the tumor) with a superior-based pedicle and reconstruction of the defect in the upper outer quadrant using an inferior-based pedicle with a small skin island was performed (Fig. 25.2). The inferior pedicle was de-epithelialized except for a small skin island of the size of the resected skin and was transferred into the defect in the upper outer quadrant and fixed to the pectoralis major muscle with nonabsorbable sutures.

Sentinel node biopsy found a macrometastatic sentinel node and axillary lymph node dissection was done. A contralateral reduction mammoplasty using a superior-based pedicle was done concomitantly for symmetrization.

Final histology found multifocal breast cancer of 15 and 8 mm which was completely resected with the closest margin being 18 mm cranially. The sentinel node was the only positive node (out of 17 excised lymph nodes).