A 45-year-old woman with a tumor just beneath the left areola was referred to our hospital. Magnetic resonance imaging (MRI) findings made us perform a core needle biopsy of the tumor, leading to the diagnosis of invasive lobular carcinoma (cT1N0M0). MRI also depicted three daughter nodules located medially to the main tumor in a linear fashion. Patient's strong request for nipple preservation made us try to resect the breast cancer in a manner to possibly preserve the nipple-areolar complex. First, to resect the target four tumors, medial horizontal skin incision at the nipple level and subsequent lower semicircular peri-areolar incision were done to the left breast. Second, small skin resection in a triangle shape and a radial fashion from the nipple bottom, i.e., orthogonal skin resection to the peri-areolar incision, was done to the areola just above the main tumor. Third, the triangle resection line was extended to the center of the parietal part of the nipple via a longitudinal skin incision on the lateral side of the nipple. Intra-nipple tissue adjacent to the sub-areolar tumor was resected as much as possible. Partially resected areola and partially incised nipple were sutured into the original shape. Pathological study showed invasive lobular carcinoma with lymphovascular invasion and widespread, i.e., total size of 60 mm, noninvasive lobular carcinoma and negative surgical margins in the nipple-areolar complex. The patient was discharged on the second day after operation, developed temporary superficial partial dermal necrosis of the nipple-areolar complex, and received adjuvant endocrine therapy, i.e., tamoxifen and luteinizing hormone-releasing hormone agonist scheduled for 10 years, and normofractionated radiotherapy to the conserved breast after full wound healing of the nipple-areolar complex.
Keywords: Areola resection; Breast cancer; Nipple incision; Nipple preservation; Sub-nipple tumor.
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