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

Mori, Hiroki; Uemura, Noriko; Okazaki, Mutsumi; Nakagawa, Tsuyoshi; Sato, Takanobu

doi:10.1007/s12282-015-0633-8

Cited by 18 publications

(21 citation statements)

References 25 publications

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“…It has been proposed that adhesion of skin and NAC to the underlying pectoralis major muscle results in lateral migration of the NAC during tissue expansion. 1 Final implant placement reduced this malposition but did not correct it. Figure 4 shows TE malposition resulting in horizontal malposition.…”

Section: Discussionmentioning

confidence: 99%

“…Malposition of the NAC is relatively common after NSM that may require repositioning surgery. Large volume resection, radial incisions, breast ptosis, and radiation are potential risk factors 1,6–9 . It has not been previously studied how nipple asymmetry after adequate tissue expansion impacts final implant nipple symmetry.…”

Section: Discussionmentioning

confidence: 99%

“…Large volume resection, radial incisions, breast ptosis, and radiation are potential risk factors. 1,[6][7][8][9] It has not been previously studied how nipple asymmetry after adequate tissue expansion impacts final implant nipple symmetry. Tissue expander insertion and expansion increased nipple asymmetry.…”

Section: Discussionmentioning

confidence: 99%

“…It has been advocated in ptotic breasts to allow the skin to contract around the implant before expansion to reduce nipple malposition. 1 Asymmetry of nipple position is common in the female population. 2,3 There are scant data on the impact of TE nipple asymmetry on final nipple symmetry after bilateral NSM.…”

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confidence: 99%

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The Impact of Tissue Expander Nipple Asymmetry on Final Implant Symmetry After Bilateral Nipple Sparing Mastectomy

Nores

Carlson

2022

Ann Plast Surg

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Background Asymmetry of nipple position is common in the female population and very difficult to correct after nipple sparing mastectomy (NSM). There are scant data on the impact of tissue expander (TE) nipple asymmetry on final implant nipple symmetry after bilateral NSM. Methods A retrospective review of an institutional review board–approved prospective database of NSM and immediate 2-stage implant reconstruction between June 2014 and December 2019 was performed. BCCT.core software was used to examine TE and final implant nipple asymmetry as well as relative breast implant position. Horizontal and/or vertical asymmetry and breast retraction assessment (BRA) were evaluated. Moderate asymmetry was defined as ≥1 cm and severe asymmetry as ≥2 cm. Lower breast contour ≥1 cm defined implant malposition. Results Twenty-three patients met the inclusion criteria. Linear regression analysis showed a significant relationship between TE BRA and final BRA (R 2 = 0.2321, P = 0.02) with a mean TE BRA of 2.04 and a mean final BRA of 1.53 (P = 0.05). Tissue expander nipple asymmetry was predictive of final BRA score: no TE asymmetry, 0.87, versus TE nipple asymmetry, 1.67 (P = 0.02). Tissue expander lower breast contour ≥1 cm occurred in 8 patients (36.4%) and was associated with implant nipple asymmetry in 7 (87.5%). The second stage of reconstruction significantly improved the nipple asymmetry in those with TE malposition (TE BRA, 2.34, vs final BRA, 1.67; P = 0.05). Two patients who received radiation had increased BRA scores (radiation, 2.14, vs no radiation, 1.47; P = 0.004). Conclusions Tissue expander nipple asymmetry as measured by BRA score or nipple asymmetry was predictive of final nipple symmetry. The second stage of TE reconstruction improves the nipple asymmetry. Final implant exchange can allow for pocket and implant manipulation, improving nipple symmetry. Radiation therapy to TE reconstruction has a negative impact on nipple symmetry after the final stage.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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The Impact of Tissue Expander Nipple Asymmetry on Final Implant Symmetry After Bilateral Nipple Sparing Mastectomy

Nores

Carlson

2022

Ann Plast Surg

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“…Risk factors for nipple malposition include breast size, breast ptosis, and radiation. [3][4][5][6][7] There is scant data on the impact of reconstructive method on nipple symmetry after bilateral NSM and immediate implant-based reconstruction.…”

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confidence: 99%

Symmetry of Nipple Position After Bilateral Nipple-Sparing Mastectomy and Implant-Based Reconstruction

2022

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Purpose Asymmetry of nipple position is common in the female population. There are scant data on the impact of bilateral nipple-sparing mastectomy (NSM) and immediate implant-based reconstruction on nipple asymmetry. Methods A retrospective review was performed of an institutional review board approved prospective database of NSM and immediate implant-based reconstruction was performed. BCCT.core software was used to examine preoperative and postoperative nipple asymmetry. It directly calculates the quantitative differences in nipple position between the breasts expressed as breast retraction assessment (BRA). Nipple to sternal notch (N-SN) asymmetry was calculated from the collected data. Results Sixty-eight patients undergoing bilateral NSM and implant reconstruction were reviewed. Reconstructive methods were tissue expander (TE) 39 (57.4%) and direct to implant (DTI) (prepectoral 13, submuscular 16) 29 (42.6%). The TE group had greater body mass index (BMI) (23.5 vs 22.1, P = 0.02), mastectomy weight (390.7 vs 243.8, P = 0.001) and higher preoperative N-SN asymmetry (TE 0.89 vs DTI 0.59, P = 0.02). Ten patients received radiation (TE group 4, DTI group 6). The TE group had larger implant size (479.1 vs 375.0, P = 0.0001). Overall, TE reconstruction resulted in an increase in nipple asymmetry (mean BRA: preoperative, 1.50 vs postoperative, 1.65), which was not significant. Direct to implant reconstruction increased nipple asymmetry: mean N-SN asymmetry preoperative 0.59 versus postoperative 0.97 (P = 0.04) and mean BRA scores 1.40 and 1.82 (P = 0.06). Both implant locations in the DTI group resulted in an increase in postoperative asymmetry but was significant for the prepectoral group: mean BRA preoperative 1.19 versus postoperative 1.85, P = 0.02 and mean N-SN asymmetry preoperative 0.48 vs postoperative 0.94, P = 0.04. Radiation impacted the final mean BRA score: radiation 2.24 versus no radiation 1.63 (P = 0.05). Conclusions Patients who underwent TE reconstruction had significantly larger breasts and greater preoperative N-SN asymmetry than the DTI group. Despite this, the TE group resulted in mild increase in nipple asymmetry. Both implant locations in DTI reconstruction resulted in increased postoperative asymmetry but was significant for the prepectoral group. Radiation therapy has a significant impact of nipple asymmetry.

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Importance of Tissue Perfusion and Assessment Methods of the Mastectomy Skin Flap

Karp

Salibian

2023

Prepectoral Breast Reconstruction

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

Abstract: In expander-implant reconstruction of a large or ptotic breast, nipple-sparing mastectomy should be performed with the expectation that ancillary procedures will be needed.

Cited by 18 publications

References 25 publications

The Impact of Tissue Expander Nipple Asymmetry on Final Implant Symmetry After Bilateral Nipple Sparing Mastectomy

The Impact of Tissue Expander Nipple Asymmetry on Final Implant Symmetry After Bilateral Nipple Sparing Mastectomy

Symmetry of Nipple Position After Bilateral Nipple-Sparing Mastectomy and Implant-Based Reconstruction

Importance of Tissue Perfusion and Assessment Methods of the Mastectomy Skin Flap

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