Changes following nipple areolar complex reconstruction and tattooing resembling a recurrent Paget's disease of the breast.

To cite: Hanafiah M, Alhabshi SMI, Mahin AH. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/ bcr-2013-201281 DESCRIPTION We present a case with images of a 50-year-old woman who was initially presented with Paget’s disease of the right breast. She then underwent a wide local excision and nipple removal of the affected breast followed by transverse rectus abdominis myocutaneous flap surgery with nipple areolar complex (NAC) reconstruction and tattooing. The 6-month postoperative follow-up revealed an irregular lump at the retroareolar region of the same breast associated with mild pain. On further enquiry, she claimed that the lump first appeared after the tattooing and it grew slightly larger and became discrete months later. On examination there was a non-tender, firm and irregular mass at the retroareolar region of the right breast. Part of the tattoo pigmentation at the reconstructed NAC region has faded with ill-defined margin (figure 1). Mammogram in craniocaudal and mediolateral-oblique views of the right breast showed irregular high-density mass at the region of the NAC, extending to the overlying skin (figure 2). Ultrasound of the left breast showed an ill-defined mass (3.0 cm×2.5 cm) with heterogeneous internal echo and posterior acoustic shadowing at the right reconstructed NAC region (figure 3). Doppler study showed minimal vascularity. Figure 1 Image of the right breast postnipple areolar complex reconstruction and nipple tattooing. The tattoo is faded with irregular outline.