Central breast cancers pose a unique challenge to oncoplastic surgeons, given their proximity to the nipple-areola complex and the impact on cosmetic outcomes. This study aims to present a comprehensive algorithm designed to optimize surgical planning and enhance aesthetic outcomes for patients undergoing surgery for central breast cancers.

This cohort study presents an algorithm designed to guide surgical decision-making for patients with central breast cancer and assesses outcomes based on its comprehensive application. Aesthetic outcomes were assessed using the Harvard Scale for physician-reported evaluation, while a modified version of the BREAST-Q questionnaire was systematically used for patient-reported aesthetic assessment.

Among 53 cases, the Harvard score was 4 in 21%, 3 in 77%, and 2 in 2% of patients. Breast-Q results revealed high satisfaction levels: 67% were “very satisfied” with their breasts, 75% “completely agreed” with satisfaction regarding the outcome, and 81% were “somewhat satisfied” with their nipples. Bland-Altman analysis presented minimal disagreement between Harvard scores and Breast-Q components, with a trend toward correlation observed (rho = 0.251, P = 0.072).

Advanced oncoplastic techniques, including reduction mammoplasty and mastopexy, offer flexible options for managing central cancers involving the NAC. Use of a nearby skin island for NAC replacement allows tailored approaches beyond the Grisotti flap, ensuring oncologic safety and improved aesthetic outcomes.