Managing Necrosis of the Nipple-Areolar Complex Following Reduction Mammaplasty and Mastopexy

  • Neal Handel
  • Sara YegiyantsEmail author


Nipple-areolar complex (NAC) necrosis is a dreaded complication of reduction mammaplasty and mastopexy that can lead to prolonged morbidity and permanent cosmetic deformity. Preventing ischemic complications is greatly preferable to treating a necrotic nipple and areola. The guiding principle in surgical management of ischemic complications of the nipple-areolar complex is to avoid aggressive treatment until the tissues have “declared” themselves. With properly timed and well-executed reconstructive procedures, it is possible in most cases to restore a very natural-appearing nipple-areolar complex.


  1. 1.
    van Deventer PV, Page BJ, Graewe FR. The safety of pedicles in breast reduction and mastopexy procedures. Aesthet Plast Surg. 2008;32:307–12.CrossRefGoogle Scholar
  2. 2.
    Gravante G, Araco A, Sorge R, et al. Postoperative wound infections after breast reductions: the role of smoking and the amount of tissue removed. Aesthet Plast Surg. 2008;32:25–31.CrossRefGoogle Scholar
  3. 3.
    Handel N. Secondary mastopexy in the augmented patient: a recipe for disaster. Plast Reconstr Surg. 2006;118(7 Suppl):152S–63S.CrossRefPubMedGoogle Scholar
  4. 4.
    le Roux CM, Pan WR, Matousek SA. Preventing venous congestion of the nipple-areola complex: an anantomical guide to preserving essential venous drainage networks. Plast Reconstr Surg. 2011;127(3):1073–9.CrossRefPubMedGoogle Scholar
  5. 5.
    Hall-Findlay EJ. Vertical breast reduction with a medially based pedicle. Aesthet Surg J. 2002;22:185–94.CrossRefPubMedGoogle Scholar
  6. 6.
    Hammond DC. Short scar periareolar inferior pedicle reduction (SPAIR) mammaplasty. Plast Reconstr Surg. 1999;103:890–901.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Antony AK, Yegiyants SS, Danielson KK, et al. A matched cohort study of superomedial pedicle vertical scar breast reduction (100 breasts) and traditional inferior pedicle Wise-pattern reduction (100 breasts): an outcomes study over 3 years. Plast Reconstr Surg. 2013;132(5):1068–76.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Lassus C. A technique for breast reduction. Int Surg. 1970;53(1):69–72.PubMedGoogle Scholar
  9. 9.
    Lejour M. Vertical mammaplasty. Plast Reconstr Surg. 1993;92(5):985–6.PubMedPubMedCentralGoogle Scholar
  10. 10.
    Hall-Findlay EJ. A simplified vertical reduction mammaplasty: shortening the learning curve. Plast Reconstr Surg. 1999;104(3):748–59.CrossRefPubMedGoogle Scholar
  11. 11.
    Singer R, Krant SM. Intravenous fluorescein for evaluating the dusky nipple-areola during reduction mammaplasty. Plast Reconstr Surg. 1981;67(4):534–5.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Murray JD, Jones GE, Elwood T. Fluorescent intraoperative tissue angiography with indocyanine green: evaluation of nipple-areola vascularity during breast reduction surgery. Plast Reconstr Surg. 2010;126(1):33e–4e.CrossRefPubMedGoogle Scholar
  13. 13.
    Wray RC, Luce EA. Treatment of impending nipple necrosis following reduction mammaplasty. Plast Reconstr Surg. 1981;68(2):242–4.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Pannucci CJ, Nelson JA, Chung CU, Fischer JP, et al. Medicinal leeches for surgically uncorrectable venous congestion after free flap breast reconstruction. Microsurgery. 2014;34(7):522–6.CrossRefPubMedGoogle Scholar
  15. 15.
    Friedman HI, Fitzmaurice M, Lefaivre JF, et al. An evidence-based appraisal of the use of hyperbaric oxygen on flaps and grafts. Plast Reconstr Surg. 2006;117(7 Suppl):175S–90S.CrossRefPubMedGoogle Scholar
  16. 16.
    Thom SR. Hyperbaric oxygen: its mechanisms and efficacy. Plast Reconstr Surg. 2011;127(Suppl 1):131S–41S.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Klatsky SA, Manson PN. Toe pulp free grafts in nipple reconstruction. Plast Reconstr Surg. 1981;68(2):2458.CrossRefGoogle Scholar
  18. 18.
    Sierakowski A, Niranjan N. Star flap with a dermal platform for nipple reconstruction. J Plast Reconstr Aesthet Surg. 2011;64(2):e55–6.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Eskenazi L. A one-stage nipple reconstruction with the “modified star” flap and immediate tattoo: a review of 100 cases. Plast Reconstr Surg. 1993;92(4):671–80.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Kroll SS, Reece GP, Miller MJ, et al. Comparison of nipple projection with the modified double-opposing tab and star flaps. Plast Reconstr Surg. 1997;99:1602–5.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Shestak KC, Nguyen TD. The double opposing periareola flap: a novel concept for nipple-areola reconstruction. Plast Reconstr Surg. 2007;119(2):473–80.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Little JW. Nipple areolar reconstruction. In: Cohen M, editor. Mastery of plastic and reconstructive surgery, vol. II. Boston: Little, Brown; 1994.Google Scholar
  23. 23.
    Hammond DC, Khuthaila D, Kim J. The skate flap purse-string technique for nipple-areola complex reconstruction. Plast Reconstr Surg. 2007;120(2):399–406.CrossRefPubMedGoogle Scholar
  24. 24.
    Becker H. The use of intradermal tattoo to enhance the final result of nipple-areola reconstruction. Plast Reconstr Surg. 1986;77(4):673–5.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Santa BarbaraUSA
  2. 2.Division of Plastic SurgeryGeffen School of Medicine at UCLALos AngelesUSA
  3. 3.Santa BarbaraUSA

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