A Novel Approach to the Management of Margin-positive DCIS in Nipple-sparing Mastectomy

Nipple-sparing mastectomy (NSM) is gaining acceptance as an oncologically sound and cosmetically superior mastectomy technique. Debate exists over the management of positive margins near the nipple-areola complex. This case report presents a novel approach to the management of margin-positive ductal carcinoma in situ in NSM. A 50-year-old white female with invasive ductal carcinoma underwent NSM. Intraoperative pathology indicated the presence of DCIS-positive retroareolar margins. Revision through a direct vertical nipple incision allowed for adequate surgical revision and pathologic evaluation of the retroareolar breast tissue while maintaining the nipple-areola skin and primary mastectomy incision. This novel approach ensures negative margins, allows superior cosmetic outcome, and improves patient autonomy in decision making. The technique may translate to NSM patients with positive retroareolar margins or false-negative margins.