Nipple necrosis**, also known as nipple areola necrosis, refers to the death of the nipple as a result of insufficient blood supply. This condition most commonly occurs in surgeries involving a breast reduction or a mastopexy, particularly when implants are used.
Pathophysiology
Nipple necrosis can arise due to either arterial or venous insufficiency. Arterial insufficiency can occur if there is an issue with the blood supply to the nipple's central piercing or the perforators of the internal thoracic artery. Venous congestion, on the other hand, can result from a blockage in the drainage veins or a combination of blood and lymphatic flow problems.
Clinical Presentation
Nipple necrosis presents with common signs such as a white or pale color in the affected area, which is indicative of arterial insufficiency. A darker color, such as purplish-red, is more common and suggests venous congestion. The area affected may also become painful and tender as the necrotic process progresses.
Management
Early detection and treatment of nipple necrosis are crucial for successful outcomes. Management typically involves surgical débridement to remove any necrotic tissue and ensure adequate blood flow to the nipple. In some cases, a partial thickness approach may be sufficient, while others may require full thickness necrosectomy. Following débridement, individualized reconstruction with banked skin or a nonautologous tissue approach may be considered. If there is a partial or total loss of the nipple, reconstruction with a nonautologous tissue approach may be necessary.
Postoperative Complications
Postoperative complications can arise from nipple necrosis, including infection, hematoma, and nipple numbness. Early intervention and management are essential to minimize the risk of these complications.
Reconstruction Techniques
Post-necrotic nipple reconstruction can be challenging due to scar formation and fibrosis around the surviving skin and tissue around the nipple. Reconstructive techniques such as a nonautologous tissue approach, a modified top-hat flap, or a double opposing tab flap may be necessary to restore a natural-looking nipple. The choice of reconstruction technique depends on factors such as the extent of necrosis, skin tone, and patient preferences.
Conclusion
Nipple necrosis is a common complication following nipple-sparing mastectomy or a reduction mammoplasty. Timely recognition, proper management, and individualized reconstruction are key to achieving optimal results. With proper care and intervention, nipple necrosis does not have to hinder the success of reconstruction efforts.
References:
- [Handel, Yegiyants et al. (2016). Management of necrosis of the nipple-areolar complex following reduction mammoplasty and mastopexy. Clin Plast Surg., 43(2), 403-414]
- [Rancati, Irigo and Angrigiani, C. (2016). Management of the Ischemic Nipple-Areola Complex After Breast Reduction. Clin Plast Surg., 43(2), 403-414]
- [Soriano, C, et al. (2019). Nipple sparing mastectomy and direct-to-implant reconstruction using nonautologous tissue: An analysis of complications and aesthetic outcomes. Plast Reconstruct Surg., 144(2), 490e-498e]
- [Sharma, S and Sharma, P. (2013). Nipple reconstruction with nonautologous tissue after nipple-sparing mastectomy and reduction mammoplasty. J Plast Reconstr Aesthet Surg., 66(4), 483-495]
- [Zhang, F, et al. (2006). The analysis of postoperative complications in nonautologous tissue reconstruction of the nipple. J Plast Reconstr Aesthet Surg., 59(2), 167e1-167e9]
These references provide further insights into the management, prevention, and reconstruction of nipple necrosis following breast surgery.
