Assoc. Martin Karamanliev, PhD
Clinical case from practice
We present the case of a patient with invasive breast cancer located centrally and involving the mammillo-areolar complex (MAC). In the past, such a finding was considered an absolute indication for mastectomy (complete breast removal) because of the risk of incomplete resection and local recurrence.
After detailed imaging (mammography, ultrasonography and MRI), a multidisciplinary oncology board and discussion with the patient, the decision was made for organ-sparing surgery with an oncoplastic approach.
What does „organ-sparing surgery“ mean?
Organ-preserving surgery (lumpectomy / breast-conserving surgery) is:
- Removal of the tumor with a sufficient surgical edge of healthy tissue
- Retaining maximum volume from the breast
- Preservation of the natural shape through oncoplastic techniques
- Subsequent radiotherapy
In this case it was done:
- Central resection with removal of the affected MAC
- Breast reconstruction by oncoplastic technique
- Biopsy of sentinel lymph nodes
Why is this important?
Until a few years ago, engaging the MAC almost automatically led to a mastectomy. Today, thanks to:
- More accurate pre-operative diagnostics
- Oncoplastic surgical techniques
- Better understanding of tumour biology
- Effective adjuvant therapy
it is possible in carefully selected patients to achieve cancer safety, combined with better cosmetic and psycho-emotional result.
Cancer Safety
Organ-sparing treatment is safe when:
- The resection lines are „clean“ (no tumor at the surgical edges)
- Patient receives postoperative radiotherapy
- The case was discussed in a multidisciplinary team
Multiple international recommendations support this approach with proper patient selection.
What was the result?
- Complete oncological resection
- Satisfactory cosmetic result
- Patient satisfaction
What do patients need to know?
- Not every nipple engagement necessarily means removing the entire breast.
- The possibilities of modern surgery have been greatly expanded.
- Each case is individual and requires judgement by a specialist breast surgery team.
