Accurate Nipple Areolar Positioning in Nipple-sparing Mastectomy Reconstruction

Mayer, Alexander; Goodreau, Adam M; Blanchet, Nadia P.

doi:10.1097/gox.0000000000002064

Cited by 5 publications

(5 citation statements)

References 16 publications

(17 reference statements)

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“…NAC xation by suture or the pull-down procedure using tape have been reported to prevent NAC malposition [19][20][21]. In our cases, no signi cant difference was observed according to the presence or absence of the pull-down operation.…”

Section: Discussioncontrasting

confidence: 44%

Nipple–areolar complex malposition in breast reconstruction after nipple-sparing mastectomy: a multi-institutional retrospective observational study in Japan

Kato,

Mori,

Saiga

et al. 2024

Breast Cancer

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BackgroundPosition of the nipple-areolar complex (NAC) is an important factor in the aesthetic impression of the breast, and NAC malposition is often an issue in breast reconstruction after nipple-sparing mastectomy (NSM). The purpose of this study was to evaluate the degree of NAC malposition depending on several factors using data quanti ed with the Mamma Balance application (Medic Engineering K.K., Kyoto, Japan). MethodsPatients who underwent unilateral breast reconstruction after NSM at 8 hospitals in Japan between 2007 and 2020 were retrospectively investigated. Using Mamma Balance, NAC malposition was quanti ed separately in horizontal and vertical directions using patient photographs from pre-operatively and 6-24 months post-operatively. The degree of malpositioning was then statistically compared using various factors. ResultsThe NAC deviated more cranially and medially with implants than with aps. Cases with latissimus dorsi ap showed lateral malposition more often than cases with deep inferior epigastric artery perforator ap. With aps, lateral incisions showed more lateral malposition and peri-areolar incisions tended to show more medial NAC malposition. In cases with severe post-operative infection of the implant, the NAC tended to deviate cranially. In radiation cases, the NAC deviated cranially. No signi cant difference was observed according to degree of breast ptosis or use of the pull-down operation. Only a very weak correlation was observed between a larger amount of mastectomy and more cranial NAC malposition with both aps and implants. ConclusionsThis study provides insights into the tendencies and characteristics of NAC malposition.

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Section: Discussioncontrasting

confidence: 44%

Nipple–areolar complex malposition in breast reconstruction after nipple-sparing mastectomy: a multi-institutional retrospective observational study in Japan

Kato,

Mori,

Saiga

et al. 2024

Breast Cancer

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“…Typical methods to address this problem include suturing of the base of the nipple to the pectoralis major muscle by traction and fixing it in place. 3,5,7 However, the anatomically correct position may not be determined in a supine position during surgery. In addition, traction suture by a single point or a few sutures is unlikely to be maintained for a long time, and in the worst case, the traction thread may detach.…”

Section: Takeawaysmentioning

confidence: 99%

“… 3 , 6 Most methods are aimed at traction of the NAC caudally or suturing the base of the nipple to the pectoralis major muscle at an appropriate location. 3 , 5 However, this often leads to unsatisfactory results. To address this issue, we have developed a method to prevent shortening and improve displacement by external fixation of the skin on the cephalad side of the breast immediately after breast implant surgery.…”

Section: Introductionmentioning

confidence: 99%

“…1,2 However, malposition of the nipple-areola complex (NAC), especially displacement in the cranial direction, often occurs and ruins the aesthetic effect, despite improving the cosmetic appearance. [3][4][5][6][7] Many methods have been described for correcting malposition of the NAC, but these are not always effective. 3,6 Most methods are aimed at traction of the NAC caudally or suturing the base of the nipple to the pectoralis major muscle at an appropriate location.…”

Section: Introductionmentioning

confidence: 99%

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Breast Splint for Prevention of Nipple–areolar Complex Malposition after Direct-to-implant Breast Reconstruction

Sowa

Kodama

Fuchinoue

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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Summary: Breast reconstruction with immediate placement of breast implants (direct-to-implant methods) following nipple-sparing mastectomy has increased because of the low burden on the patient and good aesthetic results. However, nipple–areolar complex (NAC) malposition after this surgery remains a common complication that has yet to be entirely resolved. Here, we introduce an approach using Duoactive CGF to prevent postoperative NAC malposition. Immediate postoperative fixation of Duoactive CGF cranially to the NAC of the operated breast was applied for 2–4 weeks. This is referred to as a breast splint. In the study, nine patients who received breast splints and 15 patients who did not were enrolled. The NAC position on the splint-treated breast was compared with that on the healthy side within 6 months after surgery. A case with little visual malposition was defined as having a good outcome, based on the deviation in the cranial direction not exceeding the position of the contralateral NAC. Our preliminary data demonstrated that the rate of good outcomes was significantly higher ( P = 0.028) in cases in which a breast splint was used, compared with those that were not treated with a breast splint (7/9, 78.8% versus 4/15, 26.7%). Postoperative application of a breast splint using Duoactive CGF is a simple and useful method to prevent NAC malposition after breast reconstruction, using a direct-to-implant method.

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“…has previously described using polydioxanone cable sutures to position the nipple-areola complex intraoperatively at the time of the initial mastectomy, affixing the mastectomy flap to the subjacent acellular dermal matrix. 17 She has since discovered that a barbed suture through the mastectomy flap has facilitated this technique. The shortcoming of the initial positioning technique is the same as the acellular dermal matrix revision techniques presented here: both the mastectomy flaps and the acellular dermal matrix are elastic structures subjected to the weight of the implant over time.…”

Section: Discussionmentioning

confidence: 99%

Revising Prepectoral Breast Reconstruction

Goodreau¹,

Driscoll²,

Nye³

et al. 2022

Plastic &Amp; Reconstructive Surgery

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Prepectoral prosthetic breast reconstruction continues to gain popularity, largely due to its decreased postoperative pain, animation deformity, and operative time as compared to subpectoral reconstruction. Widespread use has led to opportunities for surgical revisions. While some techniques for submuscular reconstruction revisions, such as implant exchange and fat grafting, also apply to prepectoral revisions, others require modification for the prepectoral space. The prosthesis' unique reliance on the mastectomy flaps and acellular dermal matrix for support leads to a progressive alteration of the breast footprint, conus, envelope, and nipple-areola complex position. To date, revisions of prepectoral reconstructions have not been addressed in the literature. This article presents the senior author's (N.P.B.) techniques for (1) revising prepectoral breast reconstructions, including staged and direct-to-implant reconstructions, with a special focus on nipple-sparing reconstruction, and (2) minimizing undesirable outcomes of prepectoral reconstruction.

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Accurate Nipple Areolar Positioning in Nipple-sparing Mastectomy Reconstruction

Abstract: Supplemental Digital Content is available in the text.

Cited by 5 publications

References 16 publications

Nipple–areolar complex malposition in breast reconstruction after nipple-sparing mastectomy: a multi-institutional retrospective observational study in Japan

Nipple–areolar complex malposition in breast reconstruction after nipple-sparing mastectomy: a multi-institutional retrospective observational study in Japan

Breast Splint for Prevention of Nipple–areolar Complex Malposition after Direct-to-implant Breast Reconstruction

Revising Prepectoral Breast Reconstruction

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