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CC BY-NC-ND 4.0 · Arch Plast Surg 2022; 49(05): 580-586
DOI: 10.1055/s-0042-1756292
Breast/Trunk: Original Article

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

Takako Komiya 
1   Department of Plastic and Reconstructive Surgery, Tokyo Medical University, Tokyo, Japan
,
Yosuke Ojima 
1   Department of Plastic and Reconstructive Surgery, Tokyo Medical University, Tokyo, Japan
,
Takashi Ishikawa 
2   Department of Breast Surgery, Tokyo Medical University, Tokyo, Japan
,
Hajime Matsumura 
1   Department of Plastic and Reconstructive Surgery, Tokyo Medical University, Tokyo, Japan
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Abstract

Background Appropriate position of the nipple-areolar complex (NAC) is crucial following nipple-sparing mastectomy (NSM). The prevention of NAC malposition in two-stage implant-based breast reconstruction has not been well described, and the efficacy of the techniques has not been evaluated. This study aimed to evaluate the efficacy of our technique to prevent NAC malposition in patients who underwent implant-based breast reconstruction after NSM.

Methods Patients who underwent two-stage implant-based breast reconstruction with NSM between January 2012 and December 2019 were included. We used a surgical technique to fix the NAC to the rigid base, assuming a pocket-like appearance, with pectoralis major muscle and lateral adipofascial flap at the time of tissue expander (TE) insertion. Patients were classified into two groups based on the performance of the technique for the prevention of NAC malposition.

Results In 35 patients who underwent implant-based breast reconstruction after NSM, the clavicle-to-nipple distance ratio was 96.0 ± 5.0% in those who underwent NAC fixation and 86.1 ± 11.5% in those who did not undergo NAC fixation.

Conclusions Using our technique, NAC malposition could be prevented in two-stage implant-based breast reconstruction. NAC fixation during TE insertion was found to be extremely effective. This procedure successfully prevented NAC malposition without the formation of extra scars.

Keywords

nipple-sparing mastectomy - nipple-areolar complex malposition - two-stage implant-based breast reconstruction - breast reconstruction

Ethical Approval

This retrospective single-center chart review was approved by the Institutional Review Board (IRB) of the Tokyo Medical University, Tokyo, Japan (IRB no.: T2020–0291), and performed in accordance with the principles of the Declaration of Helsinki. Written informed consent was obtained.


Authors' Contributions

T.K.: conceptualization, data curation, and preparing the original draft. Y.O.: date curation. T.I.: project administration. H.M.: project administration and writing, reviewing, and editing manuscript.


Note

This article was presented at the 9th congress of the Japan Oncoplastic Breast Surgery Society on September 16, 2021, in Tokyo, Japan.




Publication History

Received: 04 January 2022

Accepted: 23 June 2022

Article published online:
23 September 2022

© 2022. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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