Transposition Technique for Correction of a Malpositioned Nipple-Areola Complex After Reconstruction Following a Nipple-Sparing Mastectomy

Abstract

We developed a novel transposition technique for the correction of an asymmetric nipple-areola complex (NAC) due to breast mound reconstruction after a nipple-sparing mastectomy. The technique was composed of a rotation flap and an advancement flap. In this study, we describe a case of a 35-year-old woman with a malpositioned NAC located at the upper lateral position with a vertical scar in the lateral area of the breast treated by this technique, with a follow-up period of 12 years. In this case, established techniques were difficult to apply as there were thin underlying subcutaneous tissue and scars near the NAC. This technique may be useful in such a case and is an additional option in the correction of a malpositioned NAC from the upper lateral position to the ideal position on a breast mound.

Surgical Techniques to Prevent Nipple-Areola Complex Malposition in Two-Stage Implant-Based Breast Reconstruction

“…1,7 The risk factors for malposition include periareolar mastectomy incision with lateral extension, older age, wider preoperative width of breast base, a history of radiation, longer preoperative sternal notch-to-nipple distance, 7 verti-cal radical mastectomy incisions, 1 ptotic, and large resection tissue weight. 10 Secondary revision techniques for NAC include free nipple grafting, 4 subdermal pedicle flap reconstruction, 5 crescentic excision, 1 capsule modification, 1 Z-plasty technique, 11 U-plasty, 12 transposition technique, 13 and crescent periareolar skin excision. 1 In comparison with these reports, the nipple malposition rate calculated as the clavicle-to-nipple distance ratio on the affected side to that on the healthy side (the affected/healthy [b/a] ratio [%]) in group 1 without preventive technique was 86.1%, which is close to the rate of 88% reported in the literature as vertical distance ratio by Mori et al 10 In contrast, the nipple malposition ratio was 96.0% in group 3 There was a significant difference in nipple height malposition ratio (clavicle-to-nipple distance ratio) between groups 1 and 2 after 6 months of implant insertion (p ¼ 0.003).…”

Nipple malposition after nipple-sparing mastectomy and expander–implant reconstruction

“…When the nipple is unbalanced in the breast, nipple transfer by composite graft or local flap [21][22][23][24][25] can be chosen. If the nipple position is ideal, contralateral mastopexy should be performed.…”

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

“…This protocol allowed stabilization of the implant and delay of the flap, providing an ideal vascular wound bed for nipple grafting or repositioning. 18,19 None of the 17 corrected patients experienced partial-or full-thickness nipple-areola complex necrosis or recurrent malposition, and they all reported excellent results. Thus, these procedures can be considered safe and effective in well-selected nipple-sparing mastectomy patients.…”

“…13 Several procedures have been described to correct nipple-areola complex malposition, including mastopexy, free nipple grafts, 17 and various transposition techniques of subdermal pedicled flaps. 18,19 However, these corrective procedures have been presented as small case series and have not been applied to nipple-sparing mastectomy through an inframammary fold incision. Furthermore, minimal information exists on the risk stratification and complication profile of these procedures.…”