Nipple-areola Complex Research Articles

Patient Preferences and Satisfaction of Nipple Areola Reconstruction with Three-Dimensional Tattoo in the Setting of Bilateral Implant Based Breast Reconstruction

Background: Patients undergoing mastectomy for breast cancer treatment can have three-dimensional nipple areola complex (NAC) tattoos as part of their reconstructive journey. The generally accepted size and position of the NAC is noted in the literature, however, patients may have different preferences. Methods: All patients undergoing NAC tattoos were given the option to pick the size of the tattoo and location on their chest. Post-procedure measurements were obtained as well as BREAST-Q surveys to examine patient satisfaction. Results: In 104 patients, average NAC tattoo diameter was 3.62 cm (±0.45), average sternal notch to nipple was 19.53 cm (±2.66) and average nipple to inframammary fold was 8.59 cm (±2.64). On multivariable analysis, areola tattoo diameter was found to be significantly larger in patients with larger size implants ( P = .02), and Asian women ( P = .04). On multivariable analysis, sternal notch to nipple was significantly greater in patients with higher BMI ( P = .04). In patients with pre-operative photos for comparison, post-tattoo size and position of the NAC reconstruction, was significantly smaller and higher on the chest compared to their pre-operative values with an average NAC diameter of 3.60 cm (±0.46) ( P < .001), sternal notch to nipple of 19.45 cm (±2.87) ( P < .001), and nipple to inframammary fold of 8.89 cm (±2.80) ( P < .001). Sexual well-being significantly improved with an average score of 53 (±25) after micropigmentation. Conclusions: This study shows women prefer small areola size with a higher position compared to classic values, and these values may be influenced by race, BMI and implant size. Additionally, sexual well-being is improved after NAC reconstruction.

Optimization of surgical methods for the treatment of gynecomastia

Background. Gynecomastia has a negative impact on the psychological state of men. Optimisation of surgical treatment for gynecomastia, aimed at minimising unsatisfactory cosmetic consequences of operation, should significantly improve the quality of life of patients. The purpose of the study: to improve the surgical technique of treatment for gynecomastia by optimising the area of transdermal intervention with an emphasis on minimising postoperative complications and scars. Materials and methods. A total of 132 patients (mean age 31.5 ± 2.8 years, body mass index 25.2 ± 3.4, I–II ASA) were operated for gynecomastia. Gynecomastectomy (GME) was performed in patients who were randomly divided into two groups: control (C) and main (M). Patients in group C (n = 80) underwent standard GME with 10–15-mm crescentic incisions along the nipple. Patients of group M (n = 52) were operated with vertical incisions on the nipple-areolar complex at the conditional 12th and 6th hours with a length of 5–7 mm. Statistical analysis of the study results was performed according to the criteria of Pearson, Fisher and Kruskal-Wallis (Stata 12.1 package). After 3 months, the patients were questioned. The following method was used to assess surgical outcomes: 1 point — dissatisfied, 2 points — relatively satisfied, 3 points — satisfied. Results. Patients in group M had significantly fewer complications and a shorter hospital stay by 2 days (p < 0.001). 94.2 % of patients in group M at follow-up survey reported satisfaction with the results of GME in contrast to group C, where 38 % of respondents expressed dissatisfaction with the consequences of GME. The vertical incision technique showed a better cosmetic effect — a significant decrease by 13.4 times (p < 0.001) in the scar area (174.0 ± 12.0 mm2 vs. 13.0 ± 2.0 mm2). Conclusions. The use of the proposed GME demonstrated better cosmetic efficacy, namely a 13.4-fold (p < 0.001) reduction in scar area to 13.0 ± 2.0 mm2 compared with the standard GME (174.0 ± 12.0 mm2). In addition, GME patients with vertical incisions had a reduction in the length of hospital stay by 2 days (p < 0.001). The method of optimised GME demonstrated a 1.8-fold higher level of patient satisfaction with the results of the operation according to a survey conducted 3 months after GME. The use of compression garments after surgery was mandatory, which contributed to better recovery.

Gender-affirming Chest Surgery: A Prospective Series of 155 Consecutive Cases of Double Incision Mastectomy.

Mastectomy is the first single surgery that transgender men and nonbinary people frequently undergo. We present a prospective series of 155 cases of double incision mastectomy (DIM) with nipple-areolar complex (NAC) graft. From January 2019 to December 2022, 165 outpatients were operated on, and 155 are included in the study. We analyzed age, resection weight, blood loss, duration of the procedure, complications, and follow-up. The Student t test combined with the nonparametric Mann-Whitney U test was used for statistical analysis. If the P value was less than 0.05, the test was considered significant. A total of 111 (72.6%) patients experienced no complications. Complications (27.4%) were minor: 4 seromas, 8 hematomas, 10 partial necrosis of the NAC, and 8 depigmentation of the NAC. Thirteen patients presented axillary dog ears requiring secondary excision. Two patients had hypertrophic scars. No case of infection was observed. We find a statistically significant correlation between hematoma and perioperative blood loss (P < 0.05), and between dog ears requiring secondary procedure and body mass index (P < 0.001), weight of resection (P < 0.01), and blood loss (P < 0.001). DIM with NAC graft is a safe, reliable, top surgery procedure. Complications are minor, and postoperative morbidity is low. This study shows a correlation between blood loss during surgery and postoperative hematoma, and between dog ears requiring a surgery and body mass index, weight of resection, and blood loss. This surgery gives nice aesthetic results enhancing patients' quality of life by improving body image.

One Size Does Not Fit All: Prediction of Nerve Length in Implant-based Nipple-Areola Complex Neurotization.

Breast reconstruction with sensory restoration is gaining recognition as an important goal. Successful reinnervation has been shown in autologous reconstruction but not widely studied in implant-based reconstruction (IBR). This article describes our technique for nipple-areola complex (NAC) neurotization to predict maximal nerve length. We also propose a novel equation that can be utilized preoperatively to estimate the total nerve length required for NAC neurotization. This is a retrospective study of patients who underwent nerve reconstruction with IBR between April 2021 and May 2022. An equation based on the arc length of a circle was utilized to predict the total nerve length required. Postoperative assessment of sensation was performed at 3, 6, and 12 months using Semmes-Weinstein monofilament testing in all four breast quadrants and the NAC. Patients completed the Breast-Q Sensation Module preoperatively and at 3, 6, and 12 months. NAC neurotization was performed in 58 patients undergoing IBR. The average length of intercostal nerve (ICN) harvested was 5.3 cm for staged reconstructions and 5.6 cm for direct-to-implant reconstruction. The average total nerve length (allograft + mobilized ICN) was 12.3 cm. On average, 6.9 cm of nerve allograft was used. The mean difference between total nerve length and predicted nerve length was 0.47 cm (range -3.5 to 4.6 cm). There was a significant improvement in sensory monofilament values measured in all four breast quadrants and the NAC between 3 to 6 and 6 to 12 months postoperatively. A thorough understanding of sensory anatomy and precise surgical techniques are essential to perform NAC neurotization successfully. Our early results suggest the positive impact of breast sensation on patient quality of life.

Patient Satisfaction After 3D Nipple-Areola Complex Tattooing: A Case Series of Hispanic Women Following Breast Reconstruction Surgery.

Breast cancer is a prevalent cancer worldwide, leading many women to undergo mastectomy and breast reconstruction surgery. Nipple-areolar complex (NAC) reconstruction is critical in achieving aesthetic and psychological satisfaction. Recently, three-dimensional (3D) nipple-areola tattooing has become an alternative for this purpose. This study evaluates patient-reported outcomes on satisfaction among Hispanic women who underwent NAC reconstruction using 3D tattooing after breast reconstruction. Data were collected from a retrospective database in multicentric academic settings between 2014 and 2024. Participants included Hispanic women aged 32 to 60 years who received various NAC reconstruction techniques. Follow-up was conducted no more than six months after surgery, utilizing the Breast-Q version 2.0 questionnaire to measure satisfaction in two groups Group 1, in which patients received alternative NAC reconstruction methods, and Group 2, which had 3D nipple-areola tattooing. Patients who underwent 3D nipple-areola tattooing (Group 2) demonstrated increased psychosocial well-being, with a mean score of 84.73 (± 8.56). Regarding surgeon experience, Group 2 achieved a mean score of 86.21 (± 10.33), which was lower than Group 1 mean of 88.70 (± 10.78). Notably, Group 2 expressed greater satisfaction with nipple reconstruction, with a mean score of 3.73 (± 0.44) compared to Group 1 with a mean of 3.48 (± 0.65). The findings indicate that 3D nipple-areola tattooing may enhance aesthetic outcomes of the NAC and psychosocial well-being in Hispanic women. This highlights the importance of incorporating unique techniques in breast reconstruction and the need for a multidisciplinary approach.

Use of the Thermal Camera to Assess the Perfusion of the Nipple-Areola Complex and Lower Adipoglandular Flap in Post-Explantation Mastopexy.

Thermography is a valuable tool for assessing tissue temperature. In recent years, explantation surgery has increased due to the fact that, despite technological advancements, breast implants have a limited lifespan and eventually require explantation, whether for pathological, aesthetic, or personal reasons. Among the complications that can arise in breast surgery are necrosis of the nipple-areola complex (NAC) and fat necrosis of the lower dermoglandular flap, which may affect the outcomes. Considering that the blood supply and perfusion of the breast were altered during the initial surgical procedure, and the technique previously used is often unknown, it is crucial to ensure adequate vascularization of the NAC and the flap. This study demonstrates the usefulness of the thermal camera for intraoperative and postoperative monitoring of the NAC and the lower adipoglandular flap, with the goal of determining tissue perfusion and identifying hypoperfused areas for immediate management, thus providing a new safety parameter in breast surgery.Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

A Modified Periareolar Auto-augmentation Mastopexy: Using an Inferolaterally Pedicled Tongue-Shaped Parenchymal Flap.

The increasing demand for correcting ptosis has made mastopexy one of the most common procedures in plastic surgery. While various techniques have been developed, clinical outcomes often require refinement. In this study, we employed an inferolaterally pedicled, tongue-shaped parenchymal flap to perform auto-augmentation mastopexy via periareolar approach. Periareolar double-ring incisions were designed, de-epithelialization was performed between the inner and outer circles. Following subcutaneous separation of the breast parenchyma, an inferolaterally based, tongue-shaped parenchymal flap was elevated and rotated to fill posterior space of the breast, raising the nipple-areola complex (NAC). The parenchyma on both sides of the incision was sutured together to reduce the breast base and enhance central breast projection. The breast measurements and BREAST-Q scores were used to assess clinical outcomes and patients' satisfaction. Patients were also asked to rate their nipple sensation. A total of 34 female patients were retrospectively analyzed after being treated with our modified auto-augmentation mastopexy technique from January 2016 to June 2023. All patients healed without postoperative complications such as poor wound healing, hematoma, infection, or nipple necrosis. Four patients reported decreased nipple sensation postoperatively. Breast measurements revealed improved projection, nipple elevation, and significant reductions in both mammary base width and areola diameter. BREAST-Q scores indicated significant improvements in postoperative breast satisfaction and quality of life. Our modified periareolar auto-augmentation mastopexy provides a viable solution for patients with mild to severe breast ptosis, excluding cases with insufficient breast volume, seeking breast ptosis correction without synthetic materials or implants. This technique delivers natural, aesthetically pleasing results, significantly enhancing both patient appearance and quality of life. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Anatomical Approach for the Evaluation of the Nipple-Areolar Complex.

The nipple-areolar complex (NAC) is an anatomically unique region from which several normal variants and pathologies arise. Understanding its anatomy is crucial for accurate clinical and imaging assessments, aiding with differential diagnosis, and ensuring radiologic-pathologic concordance. Mammography and US are commonly used for NAC evaluation; however, these are susceptible to technical limitations such as tissue superimposition and artifacts, compromising visualization of abnormalities in this area. Although MRI offers higher sensitivity, it is not the initial evaluation modality. A comprehensive clinical inspection is necessary because it may reveal abnormalities not apparent on imaging. This article offers an anatomical approach to the NAC evaluation, simplifying differential diagnoses by reviewing imaging techniques and clinical features of common NAC abnormalities.

Targeted Reinnervation During Gender-Affirming Mastectomy and Restoration of Sensation

During gender-affirming mastectomy, nerves are transected, resulting in sensory loss. Nerve preservation using targeted nipple-areola complex (NAC) reinnervation (TNR) may restore sensation. To determine the quantitative and patient-reported sensory outcomes of TNR. Prospective matched cohort study of patients undergoing gender-affirming mastectomy from August 2021 to December 2022 at Weill Cornell Medicine and Massachusetts General Hospital. Data were analyzed from January to March 2023. Patients who underwent TNR and matched patients who did not. Mechanical detection measured with monofilaments and patient-reported outcome questionnaires were completed preoperatively and at 1, 3, 6, 9, and 12 months postoperatively. Additional quantitative sensory testing was performed preoperatively and at 12 months postoperatively. The primary outcome was mechanical detection while secondary outcomes were the additional quantitative sensory testing variables and patient-reported outcomes. Exclusion criteria included peripheral nerve disorders, unmatched patients, and incomplete follow-up. A total of 25 patients who underwent TNR and 25 matched patients who did not were included. The mean (SD) age was 24.9 (5.5) years, BMI was 26.6 (5.2), and mastectomy weight was 608.9 (326.5) g; 6 patients (12.0%) were Asian, 5 patients (10.0%) were Black or African American, and 33 patients (66.0%) were White. Repeated measures analysis of variance (ANOVA) showed that the outcomes of TNR on improving mechanical detection over time was significant at the NAC (F = 35.2; P < .001) and chest (F = 4.2; P = .045). At 12 months, mean quantitative sensory values in patients who underwent TNR reached baseline and were improved compared with patients who did not undergo TNR for monofilaments (mean [SD] NAC, 3.7 [0.5] vs 4.9 [0.9]; [data]; P < .001; chest, 3.3 [0.4] vs 3.6 [0.6]; [data]; P = .002), vibration (mean [SD] NAC, 7.7 [ 0.4] vs 7.3 [0.4]; t96 = 6.3; P < .001; chest, 7.8 [0.3] vs 7.5 [0.3]; t96 = 5.1; P < .001), 2-point discrimination (NAC, 40% vs 0%; r = 20; P = .02); chest, 4.1 [1.2] cm vs 5.7 [1.8] cm; P < .001), pinprick (mean [SD] NAC, 24.9 [21.2] mN vs 82.6 [96.7] mN; t98 = 4.1; P < .001; chest, 22.5 [25.6] mN vs 54.1 [45.4] mN; t98 = 4.6; P < .001), cold (mean [SD] NAC, 23.1 [4.7] °C vs 12.0 [7.6] °C; t98 = 8.8; P < .001; chest, 23.6 [3.1] °C vs 19.7 [5.6] °C; t98 = 4.4; P < .001), warm (mean [SD] NAC, 39.9 [5.0] °C vs 45.8 [4.2] °C; t98 = 6.3; P < .001; chest, 39.4 [3.1] °C vs 42.9 [4.0] °C; t98 = 4.9; P < .001), and pressure pain detection (mean [SD] NAC, 89.9 [45.6] kPa vs 130.5 [68.9] kPa; t86 = 3.9; P < .001; chest, 128.5 [38.0] kPa vs 175.5 [49.3] kPa; t96 = 4.0; P = .001). ANOVA demonstrated that TNR significantly improved patient-reported nipple sensation (F = 60.5; P < .001), chest light touch (F = 8.1; P = .01) and erogenous sensation (F = 8.3; P = .01). Significantly more patients who underwent TNR than those who did not reported nipple hypersensitivity until 3 months postoperatively (8% vs 4% at 12 months). In this prospective matched cohort study, TNR was associated with improved quantitative and patient-reported sensation. Patients should be counseled about the risk of transient NAC hypersensitivity.

Bilobed lateral artery perforator-based flap for partial breast reconstruction – Technique description and results from a ten-year cohort

IntroductionWe present a new technique, the bilobed lateral artery perforator-based flap, for breast-conserving surgery of large central tumors or nearby, combining Zymany's bilobed flap and a Lateral Intercostal Perforator (LICAP) flap, and its 10-year outcomes. Materials and methodsWe studied 37 patients with malignant breast tumors near or involving the central skin, without ptosis or desire to correct it, who avoided mastectomy with this modified bilobed flap from 2013 to 2022. The same surgeon operated on them in different institutions. This research project was approved by our ethical committee (n. 2.322.212). ResultsThe mean age was 57.17 (±12.60) years. The mean specimen weight was 74.32 (±25.84)g, and the mean tumor size was 40.35 (±15.81) mm. Fourteen (37.84 %) tumors were larger than 5 cm and one was multicentric. Thirty-two (86.49 %) patients had invasive ductal carcinomas. Nipple areola complex was removed in 19 (51.35 %) cases due to clinical involvement, and immediately reconstructed in two cases with contralateral free grafting. Twenty-one (56.76 %) patients received neoadjuvant chemotherapy. Three (8.11 %) patients had immediate contralateral mastopexy. Radiotherapy was indicated in all cases. There were 3 (8.11 %) minor complications, one positive margin, and no surgical revisions. In a mean follow-up of 39.97 (±29.43) months, there were no local recurrences, 2 metastasis, and one death. Satisfaction and aesthetic results were good or excellent in most cases. ConclusionsThe new technique enabled breast conservation, with high rates of free margins, high levels of satisfaction, few complications in women with large central tumors on small breasts with limited ptosis.

Surgical Algorithm of Poland Syndrome Based on Thorax, Breast, and Nipple-areola Complex Classification.

Poland syndrome (PS) is a rare congenital syndrome characterized by unilateral pectoralis major muscle defect. In 2016, we proposed the thorax, breast, and nipple-areola complex (TBN) classification and a subsequent treatment algorithm, which included conservative and surgical procedures. Our aim is to report the results we obtained treating all thoracic anomalies according to the proposed algorithm in a cohort of adolescents affected by PS. Between January 2016 and June 2023, 52 patients with PS were treated using the TBN classification in our institute. Each patient was evaluated by a multidisciplinary team composed of pediatric and plastic surgeons and treated according to the algorithm. Surgical procedures included were minimally invasive pectus excavatum repair, open sternochondroplasty, patch, metal plate, 3-dimensional chest wall prosthesis, fat grafting, tissue expanders, and breast and pectoral implants. Conservative treatments included vacuum bell and corset. Half of the patients had no thoracic skeletal defect (T1), but all had soft-tissues defects. Nineteen patients required thoracoplasty, all of whom experienced T downstaging after treatment, and 90% were postoperatively reclassified as T1. Conservative treatment for T correction was proposed in 8 patients; 83% underwent fat grafting, and 88% had a breast/pectoral prosthesis implanted. There were no major complications registered. The mean follow-up was 5.9 years. The proposed algorithm can be considered a useful tool for standardized surgical decision-making in PS. Fat grafting can play a major role in a pediatric setting. A multidisciplinary and minimally invasive approach, whenever possible, should be prioritized in patients younger than 18 years.

Patient-reported and Clinical Outcomes following Gender-affirming Chest Surgery: A Comparison of Binary and Nonbinary Transmasculine Individuals.

Nonbinary individuals assigned female at birth are increasingly presenting for gender-affirming chest surgery (GCS). However, little is known about psychosocial outcomes in this group. We compare patient-reported and clinical outcomes after GCS between nonbinary and binary transmasculine individuals who underwent GCS. We performed an institutional retrospective chart review. Demographic information, medical comorbidities, history of gender-affirming medical care, operative details, and complications were collected and compared between nonbinary and binary patients. Two validated patient-reported outcomes measures, the Gender Congruence and Life Satisfaction (GCLS) scale and the chest dysphoria measure were administered postoperatively. A total of 281 patients were included, of which 40.6% (114) identified as nonbinary and 59.4% (167) identified as binary transgender men. Fewer nonbinary patients used testosterone (P < 0.001). Nonbinary patients underwent a wider variety of masculinizing chest operations than binary patients, with fewer nonbinary patients electing for free nipple-areolar complex grafts (P < 0.001) and more nonbinary patients undergoing breast reduction (P = 0.001). A total of 137 (48.7%) patients responded to postoperative surveys. Nonbinary and binary respondents had comparable scores on the overall GCLS (P = 0.86), GCLS chest subscale (P = 0.38), and chest dysphoria measure (P = 0.40). The absence of nipple-areolar complex grafts was associated with higher GCLS chest scores (P = 0.004). Nonbinary individuals have similarly positive outcomes following GCS compared with binary individuals. Surgeons should be aware of greater medical and surgical heterogeneity in this population and seek to understand individual patients' goals and priorities.

Evaluation of Permanent Nipple-Areola Complex Sensitivity Loss Following Reduction Mammoplasty.

Predictors for permanent nipple-areola complex (NAC) insensitivity after reduction mammoplasty are sparsely defined. We analyze factors associated with NAC insensitivity over a long-term follow-up. A retrospective analysis of reduction mammoplasties on 1598 breasts performed by four surgeons from March 2015-February 2023 was conducted. Data on patient demographics, intraoperative factors, and postoperative complications were collected from patient records. Analysis was conducted by breast, separated into breasts with NAC insensitivity (permanent and transient) and those without. Wilcoxon rank sum test for continuous variables and Fisher's exact test or Pearson's Chi-square test for categorical variables evaluated differences between the groups. Univariate and multivariate logistic regression analyzed the association of pedicle choice with NAC insensitivity onset and permanence. Of 1598 breasts, 9.8% had loss of NAC sensation, of which 49.0% had permanent loss. 51.0% regained sensitivity, taking an average of 116 days (median 64, range 6-798) to regain sensation. NAC-insensitive breasts had a longer sternal notch-NAC (p<0.001) and NAC-IMF (p<0.001) measurements, greater weight removed (p<0.001), and fat necrosis co-complication (p=0.022). Greater weight removed (p=0.044) and longer sternal notch-NAC measurements (p=0.011) were associated with permanent insensitivity. The superomedial pedicle was associated with an increased rate of transient NAC insensitivity, while the inferior pedicle with a decreased rate. There was no significant association between pedicle choices and permanent insensitivity. Transient loss of NAC sensitivity is associated with pedicle choice, while breasts with permanent insensitivity were more likely to have longer breast measurements and a greater amount of tissue removed.

A nurse-led multidisciplinary service for Nipple-Areola complex tattooing after breast cancer: reporting on a complex intervention with TIDieR analysis

BackgroundThe Nipple-Areola Complex (NAC) tattooing can restore physical and mental integrity after breast cancer, but it is not always easily accessible for women. This paper aims to report on the development of a multidisciplinary nurse-led service for NAC tattooing for women who underwent breast cancer surgery with NAC removal to allow its thorough review and replication.MethodsThe Medical Research Council’s framework for developing complex healthcare interventions was followed. According to the results of a literature review, and the context analysis, an initial intervention was planned. The Template for Intervention Description and Replication checklist was chosen to ensure the quality and completeness of the intervention description.ResultsThe Breast Unit and the Research departments were engaged; three nurse-tattooists were selected; the informative material was created and shared with patients, families and local associations, involving them actively. Finally, the setting and the materials were defined. A monthly schedule of activities was set: patients with the indication for NAC tattooing were contacted by the nurse case manager. Each treatment involves 3–4 sessions, 30–40 days apart, in an ambulatory setting. It consists of NAC shaping and tattooing with a dermographer and sterile needles.ConclusionImplementing freely and equally multidisciplinary nurse-led clinics might provide this treatment ensuring the patient’s quality of life and nurse competence. The NAC tattooing is a complex intervention that represents the final part of the breast cancer surgical care pathway.

Preventing Bird’s Beak Deformity: A narrative review of Innovations in Oncoplastic Surgery

Background: In the field of breast surgery, breast conserving surgery (BCS) is widely valued for its ability to preserve the breast while also achieving cosmetically acceptable outcomes and an overall survival rate comparable to that of total mastectomy. However, BCS has not always managed to achieved satisfactory cosmetic results. Among its challenges is the “bird’s beak” deformity, which is characterized by skin retraction and a downward deviation of the nipple areolar complex due to tissue excision from the lower pole of the breast. Methods: Various forms of oncoplastic surgery (OPS) have been developed to prevent bird’s beak deformity. These include volume displacement operations (such as superior pedicle mammoplasty, rotation technique and downward-mobilization procedure), as well as volume replacement techniques, including the latissimus dorsi mini-flap, thoracodorsal artery perforator flap, lateral intercostal artery perforator flap, anterior intercostal artery perforator flap, inframammary adipofascial flap and lipofilling. Conclusion: Choosing the most suitable approach for OPS requires careful consideration of various factors, notably the defect’s size and location, the size of the breast, and the thickness of subcutaneous fatty tissue. Further studies are required to firmly position these forms of OPS techniques in an evidence-based framework.

Indocyanine Green Angiography-Assisted Pure Hemi-Periareolar Incision Nipple-Sparing Mastectomy and Direct-to-Implant Breast Reconstruction.

Although pure hemi-periareolar incisions for mastectomy can prevent visible scarring, nipple-areolar complex (NAC) necrosis is a potential risk. Superficial-arterial inflow of the NAC can be evaluated by indocyanine green angiography (ICG-A). This study evaluated the impact of ICG-A assisted periareolar incision on NAC necrosis during nipple-sparing mastectomy (NSM) and direct-to-implant (DTI) breast reconstruction. Between December 2018 and November 2021, lateral hemi-periareolar incisions for NSM were routine. After that time, ICG-A-assisted hemi-periareolar incisions were performed between December 2021 and Sept. 2023. The location of the main arterial inflow was evaluated during preoperative ICG-A and the periareolar incision was planned to avoid disruption. NAC necrosis in the ICG-A-assisted and blind-incision groups was compared using univariate and multivariate analyses. A total of 202 breasts were analyzed including 80 breasts from 75 patients in the ICG-A-assisted group and 122 breasts from 115 patients in the blind-incision group. On preoperative ICG-A, superficial-arterial inflow was observed in 67 of 80 (83.75%) breasts. Perfusion of the nipple without superficial-arterial inflow (base-perfusion pattern) was observed in 13 breasts (16.25%). The main arterial inflow was most common in the upper-medial direction at the areolar margins (65.67%). The full-thickness NAC necrosis rate in the ICG-A-assisted incision group was significantly lower than that in the blind-incision group (2.5% vs. 13.1%, p = 0.010). Multivariate analysis demonstrated that ICG-A-assisted incisions significantly reduced the risk of NAC necrosis (odds 0.155, p = 0.030). ICG-A-assisted pure hemi-periareolar incisions reduced NAC necrosis in DTI breast reconstructions.

Comparative Outcomes of Superomedial and Inferior Pedicles in Breast Reduction and Mastopexy: A Meta-Analysis of 5123 Breasts.

Superomedial and inferior pedicles are two commonly used techniques in breast reduction and mastopexy. This systematic review and meta-analysis aims to compare the clinical outcomes associated with these two techniques. PubMed, Scopus, and Web of Science were searched for relevant studies. We included all studies with data comparing superomedial and inferior pedicles. Statistical analyses were performed using RevMan version 5.4. The search yielded 1075 studies, of which 15 were included in the meta-analysis, encompassing 2633 patients (5123 breasts), with 3491 breasts receiving superomedial pedicles and 1632 breasts receiving inferior pedicles. Superomedial pedicles were associated with significantly shorter operative length (MD = - 24.71, 95% CI = - 37.63 to - 11.79, p = 0.0002), higher BREAST-Q breast satisfaction scores (MD = 10.34, 95% CI = 7.72 to 12.96, p < 0.00001), lower infection rates (RR = 0.46, 95% CI = 0.24 to 0.86, p = 0.02), higher incidence of seroma (RR = 3.00, 95% CI = 1.15 to 7.79, p = 0.02), and higher incidence of decreased nipple-areola complex (NAC) sensation (RR = 1.50, 95% CI = 1.12 to 2.01, p = 0.006). No significant differences were observed in asymmetry, fat necrosis, NAC loss, and hematoma. Superomedial pedicles demonstrated higher incidences of decreased NAC sensation and seroma formation, lower incidence of infection, shorter operative length, and higher BREAST-Q breast satisfaction scores compared to inferior pedicles. Further research is needed to confirm these findings and explore the long-term aesthetic outcomes associated with both techniques. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Staged Nipple Delay Procedure Expands Candidacy for Nipple-Sparing Mastectomy.

Nipple delay (ND) is a staged procedure that improves nipple-areolar complex (NAC) viability in nipple-sparing mastectomy (NSM) patients who are high-risk for NAC or skin-flap necrosis. This study compared postoperative outcomes and risk factors between patients treated with ND-NSM and NSM alone. Patient demographics, risk factors for NAC or skin-flap necrosis, tumor characteristics, and operative outcomes were compared between ND-NSM and NSM groups from 2009 to 2023. Univariate and multivariate analyses were performed to identify significant variables associated with NAC or skin-flap necrosis. Overall, 71 ND-NSM patients and 537 NSM patients were compared. ND-NSM patients had larger breasts (p<0.01), body mass index ≥ 30 (p=0.01), prior breast/chest wall radiation (XRT) [p<0.01], prior breast operations (p<0.01), less axillary surgery (p<0.01), more autologous tissue reconstruction over implant-based reconstruction compared with NSM patients (p=0.02), and more prophylaxis (p<0.01). There were no statistically significant differences between groups in regard to infection, skin-flap necrosis, NAC necrosis, seromas, and hematomas. No patients in the ND-NSM group had NAC necrosis and 1 patient had skin-flap necrosis, compared with 17 and 13 patients in the NSM group, respectively (p=0.24). On univariate analysis, prior XRT was associated with increased risk for skin-flap necrosis (p=0.02). Multivariate analysis showed XRT was associated with skin-flap necrosis (p=0.02) and any necrosis (p=0.01). Breast size was associated with NAC or skin-flap necrosis (p=0.04). Larger breasts and XRT were risk factors for NAC or skin-flap necrosis; however, despite having more risk factors, ND-NSM patients had very low rates of necrosis. Notably, no nipples were lost. A shared decision should be made with patients regarding the risks and benefits of ND-NSM.

Evaluation of Breast Skin/Nipple–Areolar Complex Sensation and Quality of Life after Nipple-Sparing Mastectomy Followed by Reconstruction

Background and Objectives: Sensation of the breast skin and nipple–areolar complex (NAC) is commonly assumed to be diminished or completely absent following nipple-sparing mastectomy (NSM) with implant- or expander-based reconstruction. The purpose of this cohort study was to evaluate breast skin and NAC long-term touch pressure sensibility, from 1 month to 1 year, after NSM followed by reconstruction with an implant or expander, and patient quality of life (QoL), hypothesizing that sensibility may diminish with a small progressive return throughout the postoperative period. Materials and Methods: This was achieved by performing sensation tests using Semmes–Weinstein monofilaments (SWM) in nine predefined points of the breast and NAC, a two-point discrimination test (TPD) in the four quadrants of the breast, and QoL assessment using the BREAST-Q. We evaluated 42 patients in Pauls Stradiņš Clinical University Hospital, with a total of 66 breasts, who underwent NSM between 2021 and 2023, performing the breast sensation tests before surgery and postoperatively at 1/3/6 months and 1 year. The BREAST-Q was administered to assess patient satisfaction and well-being. Results: Our results reflect a decline in breast skin and NAC sensation in the 1-month evaluation after NSM (mean: 4.67) when compared to the assessment before surgery (mean: 2.57), with a small progressive return reflected in the 3 months (mean: 3.79), 6 months (mean: 3.68), and 1-year evaluations (mean: 3.14). The following were the mean scores obtained from the BREAST-Q: Psychosocial Well-being (mean: 66), Sexual Well-being (mean: 50), Satisfaction with Breasts Pre-OP (mean: 58), satisfaction with breast reconstruction (mean: 52), Satisfaction with Implants, Satisfaction with nipple reconstruction, Physical Well-being Chest, Adverse effects of radiation, and Satisfaction with Information. Conclusions: This study confirms that sensibility diminishes after this procedure, as observed when comparing the sensation evaluation results before the operation with the 1-month evaluation, reflecting a small progressive return in the following months.

Nipple-Areola Complex Reconstruction Using FixNip NRI Implant after Mastectomy: An Innovative Technique.

Nipple-areolar complex reconstruction is the final stage of breast reconstruction, and it improves quality of life in patients with post-mastectomy breast cancer. We present a case of a patient with breast cancer underwent breast reconstruction and subsequent nipple-areolar complex reconstruction with an innovative biocompatible smooth silicone implant specially designed for a long-lasting restoration of the nipple-areola complex called FixNip NRI. However, to our knowledge, nipple-areolar complex reconstruction with FixNip was not previously reported. We present an emerging technique applied on a patient with breast cancer treated with skin-sparing mastectomy and with immediate breast reconstruction using an expander and then exchanged expander to breast implant. FixNip nipple reconstruction implant is implanted for the reconstruction of the areola-nipple complex with local-regional anaesthesia. She did not develop any postoperatively short-term or long-term complications, and her nipple slowly underwent to a gradual and better definition of its profile. This new approach regarding the reconstruction of the nipple-areola complex seems to be very promising in relation to both the degree of aesthetic satisfaction of patients and the ease of use by surgeons. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .