Management of nipple-areolar necrosis in a patient with Klippel-Trenaunay Syndrome

We present a case of a 49-year-old female with Klippel-Trenaunay Syndrome who developed partial thickness nipple-areolar complex (NAC) necrosis following explantation of breast implants with concurrent mastopexy. Notably, she had received pulse dye laser therapy to her left breast 2 years prior for treatment of a congenital capillary vascular malformations. Initial management included the use of nitropaste topically to ischemic left breast nipple areola complex, however, due to intolerance patient was switched to topical dimethyl sulfoxide, yielding improvement. This case highlights potential microvascular compromise in patient with capillary malformations of the breast undergoing breast surgery and suggests a successful application of dimethyl sulfoxide in treating NAC ischemic complications. The patient declined consent for clinical photography; therefore, we provide detailed narrative descriptions and anatomical measurements. At 12-week follow-up, the NAC had re-epithelialized completely with preserved projection and excellent symmetry. To our knowledge, this is the first reported case of this kind.