Stage 1 invasive ductal breast cancer: nipple-preserving mastectomy with reconstruction

What happened, in summary

A 62-year-old woman was referred for treatment of right invasive ductal breast cancer located directly under the nipple-areolar complex or regional nodes. The tumor caused slight nipple retraction, but mammography, ultrasound, and MRI did not show direct cancer infiltration into the nipple-areolar complex, and there was no lymphadenopathy. The cancer was ER-positive, PR-positive, HER2-negative, with Ki-67 of 28%. Because preserving the nipple mattered strongly to the patient, the team attempted nipple-preserving mastectomy rather than removing the entire nipple-areolar complex. Surgery included nipple-preserving mastectomy, sentinel node biopsy, and immediate reconstruction using an extended latissimus dorsi musculocutaneous flap. The technique involved creating a thick skin flap, fully skeletonizing the mammary gland beneath the nipple, and resecting the nipple base as close as possible while maintaining the nipple-areolar complex. Frozen section and final pathology showed clear surgical margins, and sentinel node biopsy showed no lymph node metastasis. After surgery, the nipple developed temporary color change from superficial dermal necrosis, but this healed spontaneously without sequelae. Because the breast cancer was nuclear grade 3, she received adjuvant chemotherapy. She then continued endocrine therapy. At 20 months after surgery, she remained well without recurrence. Overall, this remained hormone receptor-positive, HER2-negative invasive ductal breast cancer without lymph-node or distant metastatic disease. The immediate reconstruction proceeded safely, and the nipple-preservation technique remained compatible with clear margins in this carefully selected tumor location. Imaging before surgery was central to that decision because it showed the tumor was under the nipple but had not directly infiltrated the nipple-areolar complex.