The tumor was resected together with the overlying skin and the pectoralis major muscle fascia. Intraoperative frozen section found wide tumor-free margins. Sentinel node biopsy revealed two negative sentinel nodes. A superior-based pedicle reduction mammoplasty was performed. The inferior pedicle which usually is discarded in a reduction mammoplasty was de-epithelialized except a small skin island which corresponded to the size of the skin resected with the tumor. A tunnel was made dissecting the superior part of the breast off the fascia, and the inferior pedicle was transferred through this tunnel to reconstruct the defect in the upper quadrant of the breast (Fig. 22.2a–d).