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
