Stage II central breast cancer: oncoplastic breast-conserving surgery with hatchet and AICAP flaps

What happened, in summary

A 71-year-old woman was diagnosed with a centrally located right breast carcinoma extending into the lower inner quadrant. The tumor measured 50 mm and was staged cT2N0M0. Because it sat near the nipple-areolar complex and caused a depression in the overlying skin, safe removal required taking the nipple, areola, and involved skin as part of a wide excision. The patient strongly preferred breast-conserving surgery and wanted to preserve breast volume without scars outside the breast. Her surgical team planned an oncoplastic approach using 2 tissue flaps. Under general anesthesia, the surgeon performed a circular resection including the nipple-areolar complex and overlying skin. The operation left a central-to-lower breast defect about 90 mm wide and 25 mm deep, and the specimen weighed 110 g. A hatchet flap from the lower outer quadrant was advanced and rotated to help fill the defect. When the breast was assessed in a seated position, there was still central volume loss, so an anterior intercostal artery perforator flap was added from the upper abdomen. The AICAP flap included a crescent-shaped skin paddle and attached fat pad, supported by 2 perforators, and was folded into the central defect. Both flaps showed good blood flow. Surgery lasted 3 hours and 40 minutes, blood loss was 50 g, and she was discharged on postoperative day 6. The margin was 2 mm and considered negative. Three months after radiotherapy, the reconstructed breast remained soft, with sufficient volume and favorable cosmetic appearance. No lymph-node involvement or distant spread was reported in the clinical staging, so the emphasis of treatment was complete local removal with preservation of breast shape.