title: Nipple-Areola Complex Malposition in Nipple-Sparing Mastectomy: A Review of Risk Factors and Corrective Techniques from Greater than 1000 Reconstructions.
abstract: BACKGROUND
  Nipple-areola complex malposition after nipple-sparing mastectomy can be a challenging issue to correct. The current literature is largely limited to smaller series and implant-based reconstructions.
  
  
  METHODS
  A retrospective review of all nipple-sparing mastectomies from 2006 to 2016 at a single institution was performed. Incidence, risk factors, and corrective techniques of nipple-areola complex malposition were analyzed.
  
  
  RESULTS
  One thousand thirty-seven cases of nipple-sparing mastectomy were identified, of which 77 (7.4 percent) underwent nipple-areola complex repositioning. All were performed in a delayed fashion. The most common techniques included crescentic periareolar excision [n = 25 (32.5 percent)] and directional skin excision [n = 10 (13.0 percent)]. Cases requiring nipple-areola complex repositioning were significantly more likely to have preoperative radiation therapy (p = 0.0008), a vertical or Wise pattern incision (p = 0.0157), autologous reconstruction (p = 0.0219), and minor mastectomy flap necrosis (p = 0.0462). Previous radiation therapy (OR, 3.6827; p = 0.0028), vertical radial mastectomy incisions (OR, 1.8218; p = 0.0202), and autologous reconstruction (OR, 1.77; p = 0.0053) were positive independent predictors of nipple-areola complex repositioning, whereas implant-based reconstruction (OR, 0.5552; p < 0.0001) was a negative independent predictor of repositioning. Body mass index (p = 0.7104) and adjuvant radiation therapy (p = 0.9536), among other variables, were not predictors of nipple-areola complex repositioning.
  
  
  CONCLUSIONS
  Nipple-areola complex malposition after nipple-sparing mastectomy can be successfully corrected with various techniques. Previous radiation therapy, vertical mastectomy incisions, and autologous reconstruction are independently predictive of nipple-areola complex malposition.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: New York, N.Y.|From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center.
authors.forename: Mihye
authors.initials: M
authors.lastname: Choi
authors.affiliation: New York, N.Y.|From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center.
authors.forename: Jordan D
authors.initials: JD
authors.lastname: Frey
authors.affiliation: New York, N.Y.|From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center.
authors.forename: Ara A
authors.initials: AA
authors.lastname: Salibian
authors.affiliation: New York, N.Y.|From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center.
authors.forename: Nolan S
authors.initials: NS
authors.lastname: Karp
mesh_terms: D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D015414:Mastectomy, Subcutaneous / Q000379:methods*; D008875:Middle Aged; D009558:Nipples / Q000473:pathology* / Q000601:surgery*; D059351:Organ Sparing Treatments / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors