Restoring Confidence – MICAP Flap Reconstruction for Paget’s Disease 

Breast cancer treatment is often a journey filled with complex decisions. A 51-year-old woman, previously treated for breast cancer, presented with a new challenge—an ulcerative lesion in the nipple-areola complex (NAC). Initially misdiagnosed as triple-negative breast cancer, further evaluation at Burjeel Breast Center revealed Paget’s disease with ductal carcinoma in situ (DCIS). 

Accurate Diagnosis 

Expert review by Burjeel’s pathology team prevented unnecessary chemotherapy. This highlights the importance of second opinions and precise pathology in cancer care. 

Surgical Management 

The patient required excision of the entire NAC and surrounding ulcerated skin (8 × 6 cm). Wishing to preserve her implant-based reconstruction, she declined invasive options such as latissimus dorsi flap. The surgical team recommended a Medial Intercostal Artery Perforator (MICAP) flap with skin paddle, a muscle-sparing technique ideal for such complex cases. 

The Procedure 

Surgeons successfully performed a wide local excision followed by immediate partial breast reconstruction. The MICAP flap allowed skin resurfacing while preserving the implant. The patient recovered smoothly, with excellent cosmetic and functional results. 

Outcome and Follow-up 

Final histology confirmed Paget’s disease with DCIS—completely excised with clear margins and no invasive carcinoma. Multidisciplinary review concluded the surgery was curative, eliminating the need for further treatment. 

Conclusion 

This case underscores Burjeel Cancer Institute’s expertise in delivering personalized, minimally invasive breast reconstruction solutions, helping women regain both health and confidence after cancer surgery. 

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