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Large Nipple Volume as a Risk Factor of Nipple–areola Complex Necrosis Following Nipple-sparing Mastectomy

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A Correction to this article was published on 28 June 2022

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Abstract

Background

Nipple–areola complex (NAC) necrosis, which is caused by local ischemia, remains one of the complications associated with nipple-sparing mastectomy. Obesity, smoking, diabetes mellitus, and immediate breast reconstruction have been identified as risk factors of NAC necrosis. The current study examined the correlation between NAC necrosis and nipple volume.

Materials and methods

A total of 83 patients who underwent NSM for primary breast cancer from January 2016 to December 2019 were retrospectively analyzed. Nipple volume was determined using the formula: volume (mm3) = length × width × height (mm), with measurements determined using contrast-enhanced magnetic resonance imaging. Total and partial NAC necrosis was defined as full-thickness necrosis requiring surgical procedures and epidermal necrosis managing local wound care, respectively.

Results

NAC necrosis was observed in 30 patients (36%), with 3 and 27 patients having total and partial necrosis, respectively. Large nipple volume (56% vs. 24%, p = 0.006), as well as smoking and immediate breast reconstruction (57 vs. 28%, p = 0.017; 48% vs. 20%, p = 0.009, respectively), were significantly correlated with NAC necrosis. Multivariate analysis identified nipple volume as an independent risk factor for NAC necrosis (OR, 3.75; 95% CI, 1.23–11.44; p = 0.02). Smoking (OR, 4.68; 95% CI, 1.37–15.94; p = 0.014) and immediate breast reconstruction (OR, 3.43; 95% CI, 1.05–11.23; p = 0.042) were also independently associated with NAC necrosis.

Conclusions

This study suggested that a large nipple volume could be one of the risk factors for NAC necrosis following NSM.

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Acknowledgements

We thank Ms. Akiko Yuzuriha for her excellent technical assistance. This work was supported in part by a grant-in-aid from the Ministry of Education, Culture, and Science, Japan.

Funding

None of the authors have a financial interest in any of the products, devices, or drugs mentioned in this manuscript. No funding was received for this article. Statement of IRB Approval: Teikyo University (IRB no. 20–159).

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Authors and Affiliations

  1. Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi, Tokyo, 173-8606, Japan

    Miki Yamada, Hiromitsu Jinno, Saki Naruse, Yuka Isono, Daisuke Tsukahara, Yasuko Umemoto & Akiko Matsumoto

  2. Department of Plastic and Reconstructive Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi, Tokyo, 173-8606, Japan

    Kyoko Dogo

  3. Department of Pathology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi, Tokyo, 173-8606, Japan

    Yuko Sasajima

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  1. Miki Yamada
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Correspondence to Hiromitsu Jinno.

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The original online version of this article was revised: All instances of cc were changed to mm3.

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Yamada, M., Jinno, H., Naruse, S. et al. Large Nipple Volume as a Risk Factor of Nipple–areola Complex Necrosis Following Nipple-sparing Mastectomy. World J Surg 46, 1116–1121 (2022). https://doi.org/10.1007/s00268-022-06458-4

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