It was my pleasure to read the letter from Dr. Bovill, Dr. Macadan, and Dr. Lennox, which was a commentary on our recent article on a technique for correcting the postoperative high-riding nipple and review and classification of high-riding nipples. The authors commented that they agreed there is a certain risk of nipple elevation and migration beyond the desired level after nipple-sparing mastectomy and reconstruction with tissue expanders or implants. They propose one or more techniques to help reduce this risk or prevent it. I am familiar with those techniques, which include suturing the deep surface of overlying nipple itself or some portion of the mastectomy skin flaps to the underlying pectoralis muscle, or matrix material, if it is used. Those techniques are helpful, and should help reduce the frequency and likelihood of undesirable nipple migration. Nevertheless, the value of the article and Dr. Lennox’s Letter to the Editor is to remind surgeons that nipple-sparing mastectomy has many advantages, but one of the risks associated with it is an undesirable malpositioning of the nipple, which is often superior and lateral to the ideal.
Again, my appreciation and thanks to Dr. Bovill, Dr. Macadan, and Dr. Lennox for reading and responding to our article. I am quite confident that, in their hands, excessive superior migration of the nipple is less common than it is in the hands of others, and I think their letter helps advise both the risk of that problem and some techniques to help reduce its likelihood.
The author has no financial interest to declare in relation to the content of this communication.
Scott L. Spear, M.D.
Department of Plastic Surgery
Georgetown University Hospital
First Floor PHC Building
3800 Reservoir Road, NW
Washington, D.C. 20007
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