Supplementary Material for: Feasible nipple preservation techniques for breast cancer with slight nipple retraction

Background
Nipple retraction has long been regarded as an absolute contra-indication factor for nipple preservation in breast cancer surgery.
Case presentation
A 62-year-old woman was referred to our hospital for the treatment of breast cancer with slight nipple retraction. Imaging findings showed neither direct cancer infiltration to the nipple-areolar complex nor lymphadenopathy. Due to the patient’s strong preference, we attempted to preserve the nipple-areolar complex as follows. First, we made a quasi complete skin flap except for the nipple-areolar complex area in a thick flap manner. Second, we fully skeletonized the sub-nipple mammary gland. Next, we pinched the skeletonized sub-nipple mammary gland with the scissors and pushed the scissors toward the nipple base as close as possible with the blades kept open. After that, we resected the nipple base using the scissors on pulling the mammary gland toward the opposite direction of the nipple. Frozen section and post-operative pathological study showed clear surgical margins and no lymph node metastasis. The patient developed temporary superficial dermal necrosis of the nipple but healed without leaving any sequelae in the nipple-areolar complex. The patient has been well for 20 months without any recurrences.
Conclusion
Our nipple-preserving techniques enable safe nipple preservation even for breast cancer patients with slight nipple retraction.