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Surgical Treatment of Nipple Malposition in Nipple-Sparing Mastectomy Device-Based Reconstruction

Small, Kevin M.D.; Kelly, Kathleen M. B.A.; Swistel, Alexander M.D.; Dent, Briar L. M.D.; Taylor, Erin M. B.A.; Talmor, Mia M.D.

Plastic & Reconstructive Surgery: May 2014 - Volume 133 - Issue 5 - p 1053–1062
doi: 10.1097/PRS.0000000000000094
Breast: Original Articles
Expert

Background: This article discusses the senior author’s (M.T.) experience with nipple-areola complex malposition following nipple-sparing mastectomy, surgical options for treatment, and an analysis of risk factors.

Methods: A retrospective review was conducted on a prospectively collected institutional review board–approved database of nipple-sparing mastectomy cases with immediate device-based reconstruction performed between July of 2006 and October of 2012. Malposition was graded as mild (1 cm), moderate (2 cm), or severe (>3 cm) displacement.

Results: Three hundred nineteen nipple-sparing mastectomies were reviewed. Malposition occurred in 44 (13.79 percent). Significant factors were age (p < 0.0001), diabetes mellitus (p = 0.0025), body mass index (p = 0.0093), preoperative sternal notch–to-nipple distance (p = 0.015), preoperative breast base width (p = 0.0001), periareolar mastectomy incision with lateral extension (p < 0.0001), prior radiation (p = 0.0004), prior lumpectomy (p = 0.0125), unilateral nipple-sparing mastectomy (p = 0.0004), and postoperative nipple-areola complex ischemia (p = 0.0174). Smoking status, breast volume resected, implant size, ablative surgeon, acellular dermal matrix, and single-stage reconstruction were not significant. Nineteen patients were satisfied. Eight were not offered surgical correction because of an inadequate skin envelope. Eight had crescent mastopexy, three had implant exchange and pocket revision, four had free nipple grafts, and two had pedicled nipple transposition. There were no incidences of necrosis or malposition after surgical correction.

Conclusions: Nipple-sparing mastectomy followed by immediate device-based reconstruction has a risk of nipple malposition. Various surgical procedures are available to correct nipple malposition based on clinical presentation and are safe in certain populations.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

New York, N.Y.

From the Division of Plastic Surgery, Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medical College.

Received for publication September 9, 2013; accepted October 31, 2013.

Disclosure: At the time of submission, there were no funding sources for this work. None of the authors had a financial interest in any product mentioned in the article. Since initial submission, the senior author, Dr. Talmor, has become a consultant for Sientra, Inc. (Santa Barbara, Calif.). However, no Sientra implants were used during the course of this study.

Mia Talmor, M.D., Division of Plastic Surgery, Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medical College425 East 61st Street, 10th Floor, New York, N.Y. 10065, miatmd@aol.com

©2014American Society of Plastic Surgeons