Immediate Breast Reconstruction of a Nipple Areolar Lumpectomy Defect With the L-Flap Skin Paddle Breast Reduction Design and Contralateral Reduction Mammoplasty Symmetry Procedure: Optimizing the Oncoplastic Surgery Multispecialty Approach

Objective: We describe a modification of the inferior pedicle reduction mammoplasty for oncoplastic reconstruction of a central tumor defect. Our technique involved a deepithelialized L-shaped medial inferior based flap with removal of lateral breast tissue after central lumpectomy with a contralateral Wise-pattern mastopexy with inferior pedicle for symmetry. This technique is ideal for patients with large, ptotic breasts that desire breast conservation with immediate reconstruction. Methods: A 47-year-old woman with size 38 DD breasts presented with a palpable 2-cm subareolar mass of the left breast. Surgical oncology performed a left lumpectomy with nipple-areola complex excision and a sentinel lymph node biopsy. Immediate left breast reconstruction was performed with an inferior pedicle island flap. An additional 30 g of breast tissue was excised laterally for contour, and the neo-nipple-areola complex was rotated into the defect to facilitate inverted-T closure. A standard Wise-pattern mastopexy with inferior pedicle was then performed on the right breast and an additional 205 g of tissue was removed for symmetry. Results: The patient showed excellent symmetry at the conclusion of the procedure. Final pathology demonstrated complete excision of the tumor with negative margins. The entire neo-nipple-areola complex skin island was viable postoperatively. Conclusions: Immediate reconstruction of a nipple-areola complex lumpectomy defect with a L-shaped medial inferior based skin paddle flap and contralateral reduction mammoplasty provides an excellent cosmetic outcome in patients with large, ptotic breasts and central defects following oncologic tumor resection.