Bi-pedicle nipple-sparing mastectomy (modified Letterman technique) and TIGR mesh-assisted immediate implant reconstruction, in a patient with Cowden syndrome

A 38-year-old patient with Cowden syndrome (1,2) referred by genetics services for high-risk surveillance and consideration of risk-reducing mastectomy. She had been on regular surveillance with annual mammography and clinical examination for a few years since her diagnosis. The patient had E-cup sized breasts with grade 4 ptosis; the sternal notch to nipple measured 29 and 12 cm from nipple to inframammary fold (IMF) and was keen to reduce to C-cup breasts. Preliminary discussions favored implant-based reconstruction following mastectomy due to bilateral procedure, the patient’s desire to resume work early and look after a young and active child