Abstract
Nipple preservation is increasingly performed during therapeutic or prophylactic mastectomy; however, both short- and long-term complications can compromise the benefit of improved cosmetic outcome. Adverse events specific to nipple-sparing mastectomy are nipple ischemia and nipple-areolar complex malposition. Nipple ischemia most typically manifests with partial thickness epidermolysis or incomplete nipple-areolar complex loss that can be managed with expectant wound care alone. Typically, there is minimal eventual impact on reconstructive outcome. Nipple malposition, however, is a difficult problem that negates the major positive benefits of nipple-sparing mastectomy. This can be challenging to correct and typically requires surgical revision with breast mound repositioning, crescent mastopexy, local tissue flaps, pedicle transposition, free-nipple grafting, and excision with delayed reconstruction are all potential options. Contralateral symmetry procedures can improve the overall cosmetic result. As is often the case, prevention with careful planning and precise technique at the initial operation is the best way to avoid complications following NSM.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
van Deventer PV. The blood supply to the nipple-areola complex of the human mammary gland. Aesthetic Plast Surg. 2004;28(6):393–8.
Warren Peled A, Foster RD, Stover AC, et al. Outcomes after total skin-sparing mastectomy and immediate reconstruction in 657 breasts. Ann Surg Oncol. 2012;19(11):3402–9.
Wang F, Peled AW, Garwood E, et al. Total skin-sparing mastectomy and immediate breast reconstruction: an evolution of technique and assessment of outcomes. Ann Surg Oncol. 2014;21(10):3223–30.
Garwood ER, Moore D, Ewing C, et al. Total skin-sparing mastectomy: complications and local recurrence rates in 2 cohorts of patients. Ann Surg. 2009;249(1):26–32.
Algaithy ZK, Petit JY, Lohsiriwat V, et al. Nipple sparing mastectomy: can we predict the factors predisposing to necrosis? Eur J Surg Oncol. 2012;38(2):125–9.
Orzalesi L, Casella D, Santi C, et al. Nipple sparing mastectomy: surgical and oncological outcomes from a national multicentric registry with 913 patients (1006 cases) over a six year period. Breast. 2016;25:75–81.
Lohsiriwat V, Rotmensz N, Botteri E, et al. Do clinicopathological features of the cancer patient relate with nipple areolar complex necrosis in nipple-sparing mastectomy? Ann Surg Oncol. 2013;20(3):990–6.
Carlson GW, Chu CK, Moyer HR, Duggal C, Losken A. Predictors of nipple ischemia after nipple sparing mastectomy. Breast J. 2014;20(1):69–73.
Stolier AJ, Levine EA. Reducing the risk of nipple necrosis: technical observations in 340 nipple-sparing mastectomies. Breast J. 2013;19(2):173–9.
Wagner JL, Fearmonti R, Hunt KK, et al. Prospective evaluation of the nipple-areola complex sparing mastectomy for risk reduction and for early-stage breast cancer. Ann Surg Oncol. 2012;19(4):1137–44.
de Filho Alcantara P, Capko D, Barry JM, Morrow M, Pusic A, Sacchini VS. Nipple-sparing mastectomy for breast cancer and risk-reducing surgery: the Memorial Sloan-Kettering Cancer Center experience. Ann Surg Oncol. 2011;18(11):3117–22.
Chen CM, Disa JJ, Sacchini V, et al. Nipple-sparing mastectomy and immediate tissue expander/implant breast reconstruction. Plast Reconstr Surg. 2009;124(6):1772–80.
Sacchini V, Pinotti JA, Barros AC, et al. Nipple-sparing mastectomy for breast cancer and risk reduction: oncologic or technical problem? J Am Coll Surg. 2006;203(5):704–14.
Peled AW, Foster RD, Garwood ER, et al. The effects of acellular dermal matrix in expander-implant breast reconstruction after total skin-sparing mastectomy: results of a prospective practice improvement study. Plast Reconstr Surg. 2012;129(6):901e–8.
Lemaine V, Hoskin TL, Farley DR, et al. Introducing the SKIN score: a validated scoring system to assess severity of mastectomy skin flap necrosis. Ann Surg Oncol. 2015;22(9):2925–32.
Small K, Kelly KM, Swistel A, Dent BL, Taylor EM, Talmor M. Surgical treatment of nipple malposition in nipple-sparing mastectomy device-based reconstruction. Plast Reconstr Surg. 2014;133(5):1053–62.
Spear SL, Albino FP, Al-Attar A. Classification and management of the postoperative, high-riding nipple. Plast Reconstr Surg. 2013;131(6):1413–21.
Mohmand H, Naasan A. Double U-plasty for correction of geometric malposition of the nipple-areola complex. Plast Reconstr Surg. 2002;109(6):2019–22.
Frenkiel BA, Pacifico MD, Ritz M, Southwick G. A solution to the high-riding nipple-areola complex. Aesthetic Plast Surg. 2010;34(4):525–7.
Taneda H, Sakai S. Transposition technique for correction of a malpositioned nipple-areola complex after reconstruction following a nipple-sparing mastectomy: a case report. Ann Plast Surg. 2011;67(6):579–82.
DellaCroce FJ, Blum CA, Sullivan SK, et al. Nipple-sparing mastectomy and ptosis: perforator flap breast reconstruction allows full secondary mastopexy with complete nipple areolar repositioning. Plast Reconstr Surg. 2015;136(1):1e–9.
Basta MN, Gerety PA, Serletti JM, Kovach SJ, Fischer JP. A systematic review and head-to-head meta-analysis of outcomes following direct-to-implant versus conventional two-stage implant reconstruction. Plast Reconstr Surg. 2015;136(6):1135–44.
Reish RG, Lin A, Phillips NA, et al. Breast reconstruction outcomes after nipple-sparing mastectomy and radiation therapy. Plast Reconstr Surg. 2015;135(4):959–66.
Spear SL, Shuck J, Hannan L, Albino F, Patel KM. Evaluating long-term outcomes following nipple-sparing mastectomy and reconstruction in the irradiated breast. Plast Reconstr Surg. 2014;133(5):605e–14.
Alperovich M, Choi M, Frey JD, et al. Nipple-sparing mastectomy in patients with prior breast irradiation: are patients at higher risk for reconstructive complications? Plast Reconstr Surg. 2014;134(2):202e–6.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2017 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Chu, K.C., Losken, A. (2017). Management of Complications Following Nipple-Sparing Mastectomy. In: Harness, J., Willey, S. (eds) Operative Approaches to Nipple-Sparing Mastectomy. Springer, Cham. https://doi.org/10.1007/978-3-319-43259-5_18
Download citation
DOI: https://doi.org/10.1007/978-3-319-43259-5_18
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-43257-1
Online ISBN: 978-3-319-43259-5
eBook Packages: MedicineMedicine (R0)