Nipple-Areolar Complex (NAC) Reconstruction: Good Case

Abstract

A 52-year-old woman presented with a central mass with inclusion of the nipple-areolar complex (NAC) in her right breast in 2010. The mass was 4.5 × 4 cm large and directly behind the nipple-areolar complex and lateral at 9 o’clock. Multicentricity has been seen in radiological workup (MR mammography). The central mass had four satellite lesions posteriorly. The biopsy demonstrated an invasive ductal adenocarcinoma with middle differentiation (G2) and intraductal components with high differentiation (G1). Immunohistochemistry showed ER+++, PR+++, and her2neu -. Although it was quiet obvious that this luminal A like tumor may almost not respond to systemic chemotherapy, we offered her 6 cycles of taxane-based neoadjuvant therapy to increase her chance of a breast conservation (Fitzal et al. 2011). At the time of diagnosis, she was perimenopausal. After neoadjuvant chemotherapy, MR mammography demonstrated a partial remission (RECIST criteria). The primary tumor diameter was reduced from 4.5 × 4 to 2.5 × 2 cm and the satellite lesions from 1.2 to 0.6 cm. The NAC was still close to the lesion. Due to her large breast size (Fig. 65.1) and the partial remission (cPR), we performed breast conservation; however, intraoperative frozen section demonstrated involvement of the NAC. Thus, the NAC had to be resected as well.