Repigmentation of the Nipple-Areolar Complex Following Free Nipple Grafting.

Abstract

Free nipple grafting (FNG) is a technique historically used during breast reduction and gender dysphoria top surgery to minimize nipple areolar complex (NAC) hypoperfusion and subsequent loss. One drawback of this approach is NAC hypopigmentation. This study seeks to quantify long-term pigmentation changes in the NAC following FNG. A retrospective review of patients who underwent reduction mammoplasty or simple mastectomy with FNG from 2000-2020 at our institution was conducted. Patients were included if they had pre-operative, early, and late post-operative images. Images were analyzed using NIH Image J software for pigmentation changes over time. Of the 151 patients identified, 56 patients (111 breasts) had complete imaging (macromastia n=47; oncologic n=4; gender dysphoria n=5). All patients had NAC hypopigmentation on early imaging, with 25.5% (SD 18.1%) of the NAC affected. On late imaging, 83 NAC (74.7%) experienced repigmentation with only 8.7% (SD 7.3%) of the NAC area remaining hypopigmented. This represents a 67.2% resolution of pigmentation (p<0.001). 10 NAC (9.0%) had progression of hypopigmentation, and 17 NAC (15.3%) had no change. In a subset analysis by race, Caucasian patients had significantly greater area of NAC hypopigmentation on early post-operative imaging (Caucasian, 29.3% (SD 18.8%) vs Black, 18.3% (SD 14.0%), p<0.01). However, resolution of hypopigmentation was similar between both. While partial hypopigmentation of the NAC is nearly universal following FNG, a majority of patients experience repigmentation with low residual hypopigmentation at 1 year. These findings are useful for counseling patients with early pigmentation changes in addition to guiding surgical decisions about breast surgery with FNG.