Compromised Nipple-Areola Complex Perfusion after Reduction Mammaplasty or Mastopexy: A Retrospective Evaluation of Different Treatments.

Background: Necrosis of the nipple-areolar complex (NAC) is a rare but devastating complication after reduction mammaplasty or mastopexy. Various approaches for improving compromised perfusion of the NAC have been described. However, detailed data on this topic in the literature is still scarce. The authors aim to share the experience, treatments and outcomes of their patient collective.

Methods: All patients treated at a single institution due to compromised NAC perfusion after reduction mammaplasty or mastopexy were included. A retrospective evaluation of the patient data using electronic medical records was performed. Intraoperative and postoperative treatments, as well as interventions, were examined.

Results: A total of 31 patients (35 NACs) were included. Mean age was 48 years, mean BMI 30.8 kg/m² and mean resection weight 910.4 grams. A venous perfusion problem occurred in most cases (26, 74.3%). Statistical analysis showed a significantly better outcome for NACs treated either intraoperatively (p = 0.031) or postoperatively (p = 0.023), compared to those left untreated. Overall, 80% of all NACs healed without visible consequences (15) or with a pigment disorder (13). Five cases (14.3%) resulted in a complete loss and two cases (5.7%) in a partial loss.

Conclusions: This study represents the largest complication series in the literature. Preventing nipple necrosis due to breast reduction or mastopexy is crucial. If compromised perfusion of the NAC occurs, surgeons have various intraoperative or postoperative options available to improve circulation. Early recognition and prompt treatment are essential for the best possible outcome. Nipple necrosis can thus often be avoided.

Level of evidence iv: 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 .