Management of complications following nipple-sparing mastectomy

Nipple preservation is increasingly performed during therapeutic or prophylactic mastectomy; however, both short- and long-term complications can compromise the benefit of improved cosmetic outcome. Adverse events specific to nipple-sparing mastectomy are nipple ischemia and nipple-areolar complex malposition. Nipple ischemia most typically manifests with partial thickness epidermolysis or incomplete nipple-areolar complex loss that can be managed with expectant wound care alone. Typically, there is minimal eventual impact on reconstructive outcome. Nipple malposition, however, is a difficult problem that negates the major positive benefits of nipple-sparing mastectomy. This can be challenging to correct and typically requires surgical revision with breast mound repositioning, crescent mastopexy, local tissue flaps, pedicle transposition, free-nipple grafting, and excision with delayed reconstruction are all potential options. Contralateral symmetry procedures can improve the overall cosmetic result. As is often the case, prevention with careful planning and precise technique at the initial operation is the best way to avoid complications following NSM.