Evaluation of central quadrantectomy with immediate nipple–areola complex reconstruction for centrally located malignant breast lesions

Background
Breast cancer, according to National Cancer Institute, is the commonest cancer in women in Egypt, representing ∼39% of total malignancies among Egyptian women. It is a leading cause of mortality among them as well.
Objective
To cure patients with preservation of breast tissue as much as possible with satisfactory physical and psychological outcome. This goal has led to the introduction of a new scope of surgery into our clinical practice called oncoplastic breast surgery, with the advantage of combining oncological safety and satisfactory cosmetic outcome.
Patients and methods
This prospective study was conducted on patients with centrally located breast tumors at the General Surgery Department at Ain Shams University Hospitals starting from November 2017. Approval of the Ethical Committee and written informed consent from all participants were obtained.
Results
Our study included 30 patients who underwent central quadrantectomy with immediate reconstruction of the nipple–areola complex (NAC) for retroareolar breast cancer. Patients’ mean age was 44.1±7.51 years (30–62 years). Of 30 patients, five (16.6%) had a positive family history of mammary cancer, four (13.3%) patients were diabetic, four (13.3%) patients were hypertensive, 20 (66.6%) patients received neoadjuvant chemotherapy. The mean lesional size was 1.32±0.56 cm (0.5–2.5 cm). Operation timing was longer in inferior pedicle mammoplasty, being 2.60±0.47 h, than Grisotti mastopexy, being 1.67±0.56 h. Contralateral surgery was higher in inferior pedicle (10/15) than Grisotti mastopexy (2/15). The overall percentage of complications was 26.7%. Overall, 93.3% in Grisotti mastopexy group had good to excellent outcomes compared with 80% with good to excellent outcomes in inferior pedicle mastopexy. High cosmetic outcome was obtained thanks to the presence and shape of the breasts relatively to the esthetic outcome of modified radical mastectomy.
Conclusion
Central quadrantectomy with immediate NAC reconstruction is a good choice for patients with centrally located malignant lesions involving the NAC. These patients are no longer abutted from breast conservative surgery. Moreover, they are offered immediate reconstruction, resulting in lower rates of reoperations and recurrence and also better cosmetic appearance and higher levels of satisfaction.