Nipple malposition after nipple-sparing mastectomy and expander-implant reconstruction.

Background: Nipple malposition after nipple-sparing mastectomy and expander-implant reconstruction performed in our institute between 2002 and 2010 was studied retrospectively, targeting breast ptosis and volume.

Methods: The preoperative nipple position relative to the inframammary fold was used as the breast ptosis index. The intraoperative resected breast tissue was measured and used as the volume index. For pre- and postoperative photograph evaluation, the vertical distance of the nipple was defined as the distance from the nipple to the midpoint of the bottoms of the sternocleidomastoid muscle. The vertical distance ratio was defined as the postoperative affected-side/unaffected-side vertical distance to the preoperative one. A correlation analysis was carried out comparing the vertical distance ratios with the preoperative nipple position relative to the inframammary fold and resection tissue weight.

Results: A total of 42 cases using the expander-implant method were analyzed. The mean vertical distance ratio was 0.88. There was a comparatively high correlation between the vertical distance ratio and the resection tissue weight (correlation coefficient -0.53, P = 0.0003) and between the vertical distance ratio and the preoperative nipple position relative to the inframammary fold (correlation coefficient 0.37, P = 0.0152).

Conclusion: In expander-implant reconstruction of a large or ptotic breast, nipple-sparing mastectomy should be performed with the expectation that ancillary procedures will be needed.