The breast skin in the standing position is maximally tractioned caudally by the gravity of the breast. Therefore, after the mammary glands are excised (especially if the area extending from the nipple to the head is widely detached), the release of caudal traction, loss of supportive tissue, and atrophy of the breast skin and pectoralis major muscle due to insufficient blood flow may result in NAC deviation toward the cranial side. The primary reason for nipple migration is shortening of the soft tissue, including skin, subcutaneous tissue, and muscle, on the cranial side (Figure 3). NAC malposition often has a significant negative impact on breast symmetry and requires revision surgery. Typical methods to address this problem include suturing of the base of the nipple to the pectoralis major muscle by traction and fixing it in place.[3,5,7] However, the anatomically correct position may not be determined in a supine position during surgery. In addition, traction suture by a single point or a few sutures is unlikely to be maintained for a long time, and in the worst case, the traction thread may detach. The more straightforward surgical techniques such as capsule release and crescent mastopexy typically improve but do not entirely correct malposition, whereas the more extensive surgeries such as nipple graft or transposition result in significant scarring of the breast and sensory disturbance.[3,8] Recently, a method to correct the position of the NAC by converting the layer where the breast implant is inserted from the subpectoral to the prepectoral plane was also reported. The solution we propose here is fundamentally different from previous ideas in that it is a preventive treatment before these problems arise and does not require surgery.
Diagram showing the mechanism of displacement of the NAC in the cranial direction. Installation of a breast splint is thought to have the effect of preventing shortening due to contracture of the breast skin and pectoralis major muscles cranial to the NAC.
The prevention of NAC malposition with a breast splint introduced here was already applied for normal two-stage breast reconstruction with breast implants by the authors. This technique provides an excellent solution to these problems, including the case of DTI (Figure 3). The advantages of DuoActive CGF include simple use just by pasting, a documented history of usage in other body regions and fields, and excellent safety. In addition, the material is moderately supple, but does not easily expand or contract with the skin; thus, it works very well as a splint. Disadvantages include the possibility of contact dermatitis and additional psychological stress placed on the patient. Also, although the softness of the material is an advantage in terms of the burden on the skin and lack of wrinkling, it may bend slightly and then have an insufficient sealant effect. In such cases, reinforcement with a double layer or a breast band is required.
Treatment with a breast splint using the method described here should be continued until completion of adhesion of the detached skin envelope and pectoralis major muscle in the proper position. Considering the burden on the skin, we initially used fixation for about 2 weeks before the first outpatient visit, but the effect was insufficient in some cases. A fixation period of about 1 month is currently recommended, but a further study of the appropriate period for fixation is required.
Plast Reconstr Surg Glob Open. 2022;10(1):e3965 © 2022 Lippincott Williams & Wilkins