When breast cancer is located centrally, behind the nipple-areolar complex, mastectomy is commonly employed as the surgical strategy due to risk of deformity associated with resection of the central mound of the breast. If breast conservation is attempted without glandular reshaping, the contour of the breast is altered and often blunted resulting in loss of glandular projection. The Grisotti mammoplasty uses a local parenchymal-cutaneous flap to refill the central volume loss preserving an intact sensate breast with an idealized shape. This approach is best used in women with a moderate degree of ptosis who do not desire significant alteration in the size and shape of their breast. Given the approach uses a local advancement flap, attention to isolating perforator vessels is unnecessary. Completion of nipple reconstruction can be achieved with tattooing or a nipple reconstruction, the latter usually in a delayed fashion to allow for neovascularization of the recipient graft site. Contralateral symmetrization can be performed with a J-mammoplasty synchronously or after the completion of adjuvant radiotherapy.