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Classification and Management of the Postoperative, High-Riding Nipple

Spear, Scott L. M.D.; Albino, Frank P. M.D.; Al-Attar, Ali M.D., Ph.D.

Plastic and Reconstructive Surgery: June 2013 - Volume 131 - Issue 6 - p 1413–1421
doi: 10.1097/PRS.0b013e31828bd3e0
Cosmetic: Original Articles

Background: Postoperative nipple malposition can be an aesthetically devastating problem for patients and a formidable challenge for surgeons. The authors’ aim was to identify the common antecedent events leading to high-riding nipples, provide a classification system for these problems, and discuss management.

Methods: A retrospective review of medical records was conducted for patients who presented to the senior surgeon (S.L.S.) for management of a postoperative, excessively high nipple-areola complex over an 8-year period from January of 2004 to March of 2012. Demographic information, medical histories, operative details, and office records were reviewed for each patient. The high nipple-areola complex was classified as mild, moderate, or severe depending on the distance from the superior breast border to the top of the nipple-areola complex in relation to the vertical breast height.

Results: Twenty-five women met study criteria, with 41 breasts determined to have an excessively high nipple-areola complex. The average patient was aged 44.3 years and had undergone 2.5 ± 1.3 operations before the development of a notably high nipple-areola complex, including nipple-sparing mastectomy (32 percent), augmentation/mastopexy (29 percent), augmentation (27 percent), mastopexy (10 percent), and skin-sparing mastectomy with nipple reconstruction (2 percent). Patients were classified as having mild (27 percent), moderate (56 percent), or severe (17 percent) nipple-areola complex displacement; surgical correction was attempted in 54 percent of cases.

Conclusions: A high-riding nipple-areola complex can develop following aesthetic or reconstructive surgery. Although many patients may not need or choose correction, there are surgical options that may be helpful in improving the nipple-areola complex position.

Washington, D.C.

From the Department of Plastic Surgery, Georgetown University Hospital.

Disclosures: Dr. Spear is a consultant to LifeCell Corporation and Allergan Corporation. Neither of the other authors has any disclosures to report. No external funding supported this study.

Received for publication November 9, 2012; accepted December 28, 2012.

Department of Plastic Surgery, Georgetown University Hospital, First Floor PHC Building, 3800 Reservoir Road NW, Washington, D.C. 20007,

©2013American Society of Plastic Surgeons