Reliability and oncological safety of pedicled skin island therapeutic mammoplasty as an alternative to Grisotti mastopexy for centrally located breast cancer patients

Abstract

BACKGROUND: Centrally located breast cancers (CLBC) involving the nipple-areolar complex (NAC) pose a significant challenge for breast-conserving surgery, often necessitating mastectomy. The Grisotti flap, while a valuable oncoplastic technique, has limitations in vascular reliability and applicability, especially post-neoadjuvant chemotherapy. We introduce a novel "Pedicled Skin Island Therapeutic Mammoplasty" (PSI-TM) as an alternative. METHODS: This single-center retrospective study analyzed 23 consecutive patients with CLBC infiltrating or fixed to the NAC who underwent PSI-TM between April 2018 and June 2023. All patients had medium-to-large breast volumes (Cup C/D). Data on demographics, tumor characteristics, surgical outcomes, complications, aesthetic results, and oncological safety were collected and analyzed. RESULTS: The cohort was predominantly premenopausal (82.6%) with invasive ductal carcinoma (87.0%). Most patients (73.9%) were treated post-neoadjuvant chemotherapy. The overall complication rate was 21.7% (5/23), all Clavien-Dindo Grade I-II, with no returns to the operating room. The combined ratings from the surgeon and independent observer were 'Good' or 'Very Good' in 73.9% of cases (17/23). Over a median follow-up of 50 months, there were no instances of positive margins, local recurrence, or distant metastasis. CONCLUSION: PSI-TM is a feasible and safe oncoplastic technique for CLBC with NAC involvement. It may offer improved vascular security compared to the traditional Grisotti flap based on theoretical anatomical advantages, leading to low complication rates, excellent aesthetic results, and encouraging early oncological outcomes, even in a post-neoadjuvant setting.