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Nipple Malposition Following Nipple Sparing Mastectomy: Evaluation of Secondary Correction in Prepectoral Implant-Based Breast Reconstruction
Shahnur Ahmed, MD1, John P. Hajj, BS1, Iyad S. Ali, BS1, Ravinder Bamba, MD1, Rachel M. Danforth, MD1, R. Jason VonDerHaar, MD1, Carla S. Fisher, MD, MBA2, Kandice K. Ludwig, MD2, Mary E. Lester, MD1, Aladdin H. Hassanein, MD, MMSc1
1Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, IN
2Division of
2025-01-09
Presenter: Shahnur Ahmed, MD
Affidavit:
All of the work on this project represents the original work of the resident and co-authors.
Director Name: E. Matthew Ritter
Author Category: Other Specialty Resident
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Background:
Ptosis and large breast size are relative contraindications to nipple sparing mastectomy (NSM). However, there is no defined criteria and some ptotic patients may be offered NSM. The purpose of this study is to assess risk factors for secondary correction nipple position in prepectoral implant-based reconstruction to help guide surgical decision-making and patient counseling.
Methods:
Patients at our center who underwent NSM and immediate prepectoral tissue expander (TE) reconstruction were reviewed. Patients who had immediate nipple position adjustment during the day of the mastectomy were excluded. Patients were divided into two groups: Group 1 (secondary nipple adjustment during TE to implant exchange) and Group 2 (no secondary nipple adjustment). Periareolar crescentic advancement was used for nipple correction. Preoperative sternal notch-to-nipple distance, Regnault classification ptosis grade, pre-operative bra cup size, and mastectomy weights were assessed.
Results:
The study included 171 patients: 46 patients in Group 1, 125 patients in Group 2. Grade II ptosis was present in 78.3% (36/46) of Group 1 compared to 58.4% (73/125) of Group 2 (p=0.0196). The average preoperative sternal notch-to-nipple distance for Group 1 was 26.3�3.0 cm compared to 24.7�3.9 cm for Group 2 (p=0.001). There was no difference in preoperative cup size between groups (p=0.7298). The average mastectomy weight in Group 1 was 565.7�271.6 grams compared to 449.4�264.3 grams (p=0.008).
Conclusion:
Patients who undergo NSM with Regnault grade II ptosis, sternal notch-to-nipple >26 cm are more likely to require secondary nipple correction. The findings can improve patient counseling and set expectations.
