Breast Cancer

, Volume 26, Issue 1, pp 58–64 | Cite as

Quantitative assessment and risk factors for nipple–areolar complex malposition after nipple-sparing mastectomy

  • Takaya Makiguchi
  • Hideharu Nakamura
  • Takaaki Fujii
  • Satoshi Yokoo
Original Article



Nipple sparing mastectomy (NSM) for breast cancer preserves the nipple–areola complex (NAC) and has limited the extent of the scar, giving good cosmetic results. However, NAC malposition may occur. The aim of this study is to evaluate NAC malposition after NSM and to determine factors associated with malposition in two-stage reconstruction.


The subjects were 46 patients who underwent unilateral NSM, without contralateral mastopexy or reduction surgery, in two-stage reconstruction using an expander with implant or flap replacement. Vertical and horizontal NAC malposition and predictors of malposition were evaluated before and more than 1 year after reconstruction surgery.


The total amount of saline injected into the expander and aging were significant predictors of increased superior malposition of NAC before and more than 1 year after reconstruction or implant surgery. In contrast, the amount of saline injected into the expander until 2 weeks after expander insertion was a significant predictor of decreased superior NAC malposition. BMI was also a statistically significant predictor of decreased superior NAC malposition, but this result was likely to have been due to the measurement method. Autologous reconstruction was a significant negative predictor of superior malposition at more than 1 year after surgery. Superior NAC malposition resulting from full expansion of the expander improved by a mean vertical angle of 4.5° after autologous reconstruction, but hardly improved after implant use. In autologous reconstruction, NAC tended to move slightly to the lateral side after autologous reconstruction, compared to implant use.


Until 2 weeks after expander insertion, as much saline as possible should be injected to prevent superior NAC malposition. At full expansion, superior malposition of vertical angle > 4.5° may require repositioning surgery.


Nipple-sparing mastectomy Nipple–areolar complex Nipple Malposition 



Funding was from institutional sources only.

Compliance with ethical standards

Conflict of interest

The authors have declared that no conflicts of interest exist.


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Copyright information

© The Japanese Breast Cancer Society 2018

Authors and Affiliations

  • Takaya Makiguchi
    • 1
    • 4
  • Hideharu Nakamura
    • 1
  • Takaaki Fujii
    • 2
  • Satoshi Yokoo
    • 3
  1. 1.Department of Plastic and Reconstructive SurgeryGunma University HospitalMaebashiJapan
  2. 2.Department of Integrative Center of General SurgeryGunma University HospitalMaebashiJapan
  3. 3.Department of Oral and Maxillofacial SurgeryGunma University HospitalMaebashiJapan
  4. 4.Department of Oral and Maxillofacial Surgery, and Plastic SurgeryGunma University Graduate School of MedicineMaebashiJapan

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