D89. Nipple Areolar Malposition versus Ideal Position after Nipple-Sparing Mastectomy Reconstruction

PURPOSE: Malposition of the nipple areolar complex (NAC) is a non-optimal complication of nipple-sparing mastectomy (NSM) reconstruction, NSM that preserves the NAC and surrounding skin and results in both a more naturally appearing reconstructed breast and improved patient quality-of-life. NAC malposition may undermine these major reconstructive benefits, but there are various aspects of surgical technique that may potentially affect the NAC positioning: use of acellular dermal matrix (ADM), reconstruction type (direct-to-implant vs tissue expander), implant or tissue expander plane of placement, and mastectomy incision location. METHODS: To better understand NAC malposition and these potential surgical factors, measurements and data were recorded for 88 NSM reconstruction patients between January 2020 and May 2023. Statistical analyses comparing actual and ideal measurements were completed and demonstrated that, while patients' measurements strayed from the ideal at both pre-operative and post-operative timepoints, most patients had worsened malposition post-operatively compared to pre-operatively. Analyses of the surgical variables was performed using mixed effect regression models. RESULTS: Findings were significant for ADM usage (p=0.003 and p<0.001) and direct-to-implant reconstruction type (p=0.058 and p=0.029), being associated with NAC malpositioning along the vertical axis. Subpectoral placement of tissue expanders or implants (p=0.012 and p=0.011) and breast-splitting mastectomy incision type (p=0.003) were found to result in increased malposition. CONCLUSION: These findings demonstrate how certain NSM reconstruction surgical techniques may influence NAC positioning by highlighting which variables may have a higher risk of NAC malpositioning. These factors should be carefully considered with surgeons' operative planning and with patient counselling regarding reconstructive options.