“…Patients with evidence of direct nipple involvement of tumor, Paget's disease, inflammatory breast cancer, tumor size > 3 cm, or tumor < 2 cm from nipple center may not be suitable candidates for NASM because of an increased risk of local tumor recurrence (Brachtel et al, 2009;Cunnick & Mokbel, 2006). Following NASM, the quality of the preserved skin is an important consideration for direct-to-implant reconstruction because extremely thin skin or compromised skin increases the risk of ischemia and skin necrosis which can eventually lead to implant loss (Woerdeman et al, 2006).…”