Reverse-Mirrored Grisotti Flap For Central Breast Cancer: El-Erian's Modification

Central (retro-areolar) breast cancers were previously considered a contraindication to breast-conserving surgery and so were inevitably treated with mastectomy because of that central quadrantectomy will lead to breast deformity and bad cosmesis. Grisotti dermoglandular flap technique was an excellent solution to this problem. The original description of Grisotti flap was laterally oriented and depended mainly on the lateral thoracic vessels. it is ideal for purely central tumors and Paget`s disease of the nipple and areola. However, sometimes central tumors are somewhat eccentric with para-areolar extension within the territory of the Grisotti flap (L.O.Q from 3 to 6 o`clock). So we proposed a modification in the form of a Reverse-Mirrored flap that is medially oriented and depended mainly on the internal mammary vessels to solve this problem and was found to be even more aesthetically pleasing in addition of having a more versatile blood supply.