Breast Splint for Prevention of Nipple–Areolar Complex Malposition After Direct-to-Implant Breast Reconstruction

Yoshihiro Sowa, MD, PhD; Takuya Kodama, MD; Yuko Fuchinoue, MD; Naoki Inafuku, MD; Yasunobu Terao, MD, PhD


Plast Reconstr Surg Glob Open. 2022;10(1):e3965 

In This Article

Abstract and Introduction


Breast reconstruction with immediate placement of breast implants (direct-to-implant methods) following nipple-sparing mastectomy has increased because of the low burden on the patient and good aesthetic results. However, nipple–areolar complex (NAC) malposition after this surgery remains a common complication that has yet to be entirely resolved. Here, we introduce an approach using Duoactive CGF to prevent postoperative NAC malposition. Immediate postoperative fixation of Duoactive CGF cranially to the NAC of the operated breast was applied for 2–4 weeks. This is referred to as a breast splint. In the study, nine patients who received breast splints and 15 patients who did not were enrolled. The NAC position on the splint-treated breast was compared with that on the healthy side within 6 months after surgery. A case with little visual malposition was defined as having a good outcome, based on the deviation in the cranial direction not exceeding the position of the contralateral NAC. Our preliminary data demonstrated that the rate of good outcomes was significantly higher (P = 0.028) in cases in which a breast splint was used, compared with those that were not treated with a breast splint (7/9, 78.8% versus 4/15, 26.7%). Postoperative application of a breast splint using Duoactive CGF is a simple and useful method to prevent NAC malposition after breast reconstruction, using a direct-to-implant method.


Nipple-sparing mastectomy has been shown to be oncologically safe based on wide clinical experience, and immediate breast reconstruction using breast implant surgery (direct-to-implant [DTI]) is increasingly performed for patients with breast cancer.[1,2] However, malposition of the nipple-areola complex (NAC), especially displacement in the cranial direction, often occurs and ruins the aesthetic effect, despite improving the cosmetic appearance.[3–7] Many methods have been described for correcting malposition of the NAC, but these are not always effective.[3,6] Most methods are aimed at traction of the NAC caudally or suturing the base of the nipple to the pectoralis major muscle at an appropriate location.[3,5] However, this often leads to unsatisfactory results. To address this issue, we have developed a method to prevent shortening and improve displacement by external fixation of the skin on the cephalad side of the breast immediately after breast implant surgery. In this method, we use hydrocolloid dressing as a splint material, which we refer to as a breast splint. Here, we introduce the procedure and show that this approach can prevent NAC malposition after direct-to-implant immediate breast reconstruction.