Neo-Areola Inferior Flap after Total Nipple-Areolar Complex Excision for a Syringomatous Tumor of the Nipple: A Case Report and Literature Review

Syringomatous tumor of the nipple (SyT) is a rare benign adnexal neoplasm that typically originates within the nipple-areolar complex (NAC), making complete NAC excision essential to achieve negative margins and prevent recurrence. We present the case of a 35-year-old woman with biopsy-proven SyT and positive margins who was treated with total NAC excision followed by immediate reconstruction using an inferior pedicle dermoadipose flap designed with a Wise-pattern approach and a superior skin island to create a neo-areola. The technique provides reliable vascularity, central volume replacement, and a stable neo-areola in a single stage. Final pathology confirmed wide negative margins (deep margin 20 mm; peripheral margins 20 mm). At the six-month follow-up, the patient demonstrated excellent symmetry and no evidence of recurrence. This case highlights a reproducible oncoplastic strategy for situations in which oncologic safety requires NAC excision, offering an alternative option for central breast reconstruction in rare tumors such as SyT.