Case Presentation
A Caucasian woman, aged 53, presented to the breast surgery department with a small nodule on her left nipple, self-diagnosed 6 months prior to her visit. The patient reported that the nodule had slightly increased in size, had formed a traumatic surface and a mildly hemorrhagic discharge had been produced. The patient had a negative personal and family history for cancer, no breast cancer risk factors, no other comorbidities or administered medications. She did not recall any trauma on her left breast and reported no other symptoms, like itching. On clinical examination the nodule was soft, fragile and bled easily. The physical examination, ultrasound scan and mammography of the breasts were negative for any associated pathology. Cytology examination of the nipple discharge was negative for cancerous cells and scanty presence of red cells was reported.
The hypothesis of NA was proposed and the patient was referred to a dermatologist, who performed a punch biopsy in order to confirm the diagnosis. Histopathology examination revealed benign nodular glandular proliferation on the nipple area embedded in a fibrotic stroma. Immunohistochemical evaluation using the p63 / h-caldesmon cocktail, revealed the presence of myo-epithelial cells. Cytokeratin 5/6 identified features of usual ductal hyperplasia, whereas the estrogen receptor expression was low. The diagnosis of nipple adenoma was confirmed with the typical histological and immunohistochemical features. The excision of the lesion confirmed the initial biopsy diagnosis (Figure 1) .
The patient underwent surgical excision of the nipple adenoma under local anesthesia. Prior to the procedure, the patient was marked twice pre-operatively around the areola region (Figure 2) with a distance that aimed to be similar to the protrusion of the right nipple. The NAC of this patient had an adequate size and her breasts were rather large. After the complete excision of the nipple, which was completely covered with the adenoma, two purse string sutures were placed at the remaining areola; one at the edge of the incision, and one at the periphery, at such a distance to allow adequate projection, mimicking the one of the right nipple. Tightening of the two sutures was applied with caution in order to avoid any tension during healing process.(Figure 2) . The patient fully recovered with no complications and was discharged one hour after the procedure. The patient was inspected at 10 days and 4 months post-operatively and underwent follow-up diagnostics every 6 months. There was minimal flattening of the area but enough projection to mimic a nipple. The patient reported satisfactory aesthetic result and had no intention of further aesthetic interventions. There were no adverse and/or unanticipated events observed. The patient signed an informed consent form according to the institutional regulations for this publication.