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Diabetic mastopathy (DMP) is a rare, fibroinflammatory condition of the breast most commonly affecting pre-menopausal women with long standing, poorly controlled diabetes. Although benign in nature, this condition often presents as nodules within the breast and in some cases, these can be painful and distort the breast tissue. As a consequence, quality of life can be significantly affected. Management of these presents a challenge; there is little in the published literature and no established best practice. High rates of disease recurrence have been reported with localized surgical excision and is not recommended. We present the first reported case of extensive, painful DMP managed with nipple sparing mastectomy and immediate free flap reconstruction. Multi-disciplinary team input and careful peri-operative diabetic management led to a successful outcome with complete resolution of symptoms and an improved breast contour. There are no signs of disease recurrence at two years of follow-up. Definitive removal of diseased tissue can relieve symptoms and prevent the need for multiple procedures and unnecessary stressful investigations. Discrepant breast volume can be corrected with a well-planned autologous reconstruction and a deep inferior epigastric perforator (DIEP) flap can provide an ideal donor site. Successful treatment of these challenging patients can be achieved through collaboration between specialities.

Use of deep inferior epigastric perforator flap reconstruction as single-stage definitive treatment of symptomatic diabetic mastopathy: a case report