Defect Reconstruction with Inferomedial Pedicle Technique

Abstract

A 41-year-old female presented to the hospital with chest pain and on exam was found to have a 1.5-cm centrally located mass on the right breast. The patient underwent bilateral mammogram, which noted an increased asymmetric density at the medial right breast. The lesion was in the posterior region of the breast at approximately the 3-o’clock position. Biopsy revealed invasive ductal carcinoma, ER/PR positive and HER2/neu negative. The patient was subsequently referred to MD Anderson for further treatment. Repeat imaging demonstrated the presence of a 2.5-cm mass with spiculated margins at the upper inner quadrant of the right breast. The patient elected to undergo breast conservation therapy, and therefore right breast needle-localized segmental mastectomy, intraoperative lymphatic mapping, and right axillary sentinel lymph node dissection were planned. Secondary to the presence of symptomatic macromastia (bra size 36DD), decision was made to proceed with local tissue rearrangement in a breast reduction fashion, with the use of inferomedial pedicle. We also decided to proceed with local tissue rearrangement and breast reduction only on the right side, in order to perform symmetry procedure on the contralateral side, after the completion of adjuvant radiation and analysis of the overall postoperative and radiation result. Final pathology confirmed the presence of pT1c N0 M0 and stage I right breast invasive ductal carcinoma, as well as associated DCIS and negative margins. She received a total of 60-Gy adjuvant radiation and hormonal therapy with tamoxifen. Since her Oncotype DX test revealed her recurrence score to be very low, she did not receive adjuvant chemotherapy.