European Journal of Plastic Surgery

, Volume 41, Issue 4, pp 369–378 | Cite as

Management of nipple-areola complex ischemia after breast reduction: A systematic literature review and algorithm proposal

  • Alexandre Vairinho
  • Kevin Serror
  • Antoine De Runz
  • Warren Noel
  • Marc Chaouat
  • Maurice Mimoun
  • David Boccara



Rare and dreaded, necrosis of the nipple-areola complex (NAC) is one of the major complications of breast reduction surgery. Our objective was to establish a management algorithm summarizing the different possible treatments reported in the literature.


The data extracted from the articles selected for this literature review covered surgical techniques, frequency of NAC necrosis, type of necrosis, and management proposed for women who have had this surgery for macromastia.


In the 54 articles finally selected, the mean frequency of NAC necrosis was 5.1%. The risk factors for necrosis were the weight of the tissue resected, smoking, obesity, the surgical technique used, and stretch marks. The treatments proposed were listed according to four categories of issues: patient-specific susceptibility, type of breast, surgical technique, and its technical performance.


No consensus exists about the management of NAC necrosis, which remains a complication feared by surgeons. We propose a management algorithm that simplifies the therapeutic indications.

Level of Evidence: Not ratable


Necrosis NAC Necrosis nipple-areola complex Breast reduction Outcomes Reduction mammoplasty Reduction mammaplasty Complications 


Compliance with ethical standards



Conflicts of interest

A. Vairinho, K. Serror, A. De Runz, W. Noel, M. Chaouat, M. Mimoun, and D. Boccara declare that they have no conflict of interest.

Ethical approval

Not required.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Alexandre Vairinho
    • 1
  • Kevin Serror
    • 1
  • Antoine De Runz
    • 1
  • Warren Noel
    • 1
  • Marc Chaouat
    • 1
  • Maurice Mimoun
    • 1
  • David Boccara
    • 1
  1. 1.Department of Plastic, Reconstructive, Aesthetic and Burn SurgeryHospital Saint-LouisParisFrance

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