Nipple Malposition Following Nipple-Sparing Mastectomy: How Can We Prevent It?
Nipple-sparing mastectomy is the latest evolution in mastectomy technique, providing superior cosmetic results without compromising oncological safety. A potential complication of the procedure is the malposition of the nipple in the reconstructed breast which is mainly either lateral displacement of the nipple or the so-called high-riding nipple-areolar complex (NAC). Following nipple-sparing mastectomy, immediate reconstruction is almost always applied either with a silicone breast implant or a tissue expander. The patient during surgical procedure is turned to a sitting position to estimate the proper nipple-areolar position in the reconstructed breast in comparison with the contralateral breast. A mark on the proper position at the anterior surface of the pectoralis major muscle corresponding to the posterior part of the nipple-areolar complex is made. Two or three absorbable Vicryl 3-0 sutures are placed to stitch the posterior border of the nipple on the marked area of the pectoralis major muscle. These sutures are placed in order to prevent migration of the nipple-areolar complex which is usually superiorly and laterally.