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

다국어 초록 (Multilingual 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 pectoralismajormuscle 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 96.05.0% in thosewho underwent NAC fixation and 86.111.5% 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.

참고문헌 (Reference)

1 Taneda H, "Transposition technique for correction of a malpositioned nipple-areola complex after reconstruction following a nipple-sparing mastectomy : a case report" 67 (67): 579-582, 2011

2 Takayanagi S, "Transposition of the malpositioned nipple-areola complex in breast reconstruction with implants" 34 (34): 52-58, 2010

3 Small K, "Surgical treatment of nipple malposition in nipple-sparing mastectomy device-based reconstruction" 133 (133): 1053-1062, 2014

4 Wagner JL, "Prospective evaluation of the nipple-areola complex sparingmastectomy for risk reduction and for early-stage breast cancer" 19 (19): 1137-1144, 2012

5 Djohan R, "Patient satisfaction following nipple-sparing mastectomy and immediate breast reconstruction : an 8-year outcome study" 125 (125): 818-829, 2010

6 Jabor MA, "Nippleareola reconstruction : satisfaction and clinical determinants" 110 (110): 457-463, 2002

7 Choi M, "Nipple-areola complex malposition in nipple-sparing mastectomy : a review of risk factors and corrective techniques from greater than 1000 reconstructions" 140 (140): 247e-257e, 2017

8 Flessas I, "Nipple malposition following nipple-sparing mastectomy. How can we prevent it?" 22 (22): 131-132, 2016

9 Mori H, "Nipple malposition after nipple-sparing mastectomy and expander-implant reconstruction" 23 (23): 740-744, 2016

10 Metcalfe KA, "Long-term psychosocial functioning in women with bilateral prophylactic mastectomy : does preservation of the nipple-areolar complex make a difference?" 22 (22): 3324-3330, 2015

11 Doren EL, "Free nipple grafting : an alternative for patients ineligible for nipple-sparing mastectomy" 72 (72): S112-S115, 2014

12 Rietjens M, "Free nipple graft technique to correct nipple and areola malposition after breast procedures" 1 (1): e69-, 2013

13 Mohmand H, "Double U-plasty for correction of geometric malposition of the nipple-areola complex" 109 (109): 2019-2022, 2002

14 Swanson E, "Correction of postoperative nipple/areola malposition without nipple grafting" 2 (2): e117-, 2014

15 Frenkiel BA, "A solution to the high-riding nipple-areola complex" 34 (34): 525-527, 2010