Feasible Nipple Preservation Techniques for Breast Cancer Under the Nipple-Areolar Complex: A Case Report

We present our nipple preservation techniques for breast cancer under or near the nipple-areolar complex through actual surgical procedures in a 59-year-old patient with node-negative luminal breast cancer. Our main surgical points for nipple preservation against juxta-nipple breast cancer were as follows. First, we made an extended peri-areolar incision. Second, we left the subcutaneous fat near the nipple in a thick flap manner on skin flap formation to ensure venous drainage from the nipple-areolar complex. Then, we incised the distal mammary gland with safety margins, bluntly dissected the retromammary space to manually palpate the breast cancer in order to avoid off-center resection, forwarded the mammary gland incision cranially and caudally toward the nipple, and completely skeletonized the mammary gland just under the nipple. Finally, we resected the sub-nipple mammary gland at the lactiferous level with the nipple slightly depressed below the surrounding skin by pulling the breast tissue to be resected, leading to maximal removal of the mammary gland, including some intra-nipple mammary ducts. After the pathological confirmation of negative surgical margins at the nipple base and node negativity, the patient received postoperative radiation therapy to the conserved breast and has been well for seven months on letrozole therapy. Breast surgeons should be familiar with these surgical procedures for feasible nipple preservation in juxta-nipple breast cancer.