The Modified Nipple-Areola Preservation Procedure: An Evolution of the Technique After 10 Years of Experience

The nipple-areola preservation (NAP) procedure was introduced by the authors in 2015 as a way to increase the survivability of the native skin breast envelope and nipple-areola complex (NAC) in patients undergoing nipple-preserving mastectomies. By undermining the central mastectomy flap 2 weeks before the planned mastectomy, the skin and NAC benefit from the delay phenomenon, resulting in improved vascularity and survivability. In addition, the NAP allows the breast surgeon to identify subareolar malignant extension and sentinel lymph node status before mastectomy and reconstruction. After 10 years of experience with this procedure, the authors have streamlined the technique, resulting in fewer complications and allowing nipple repositioning at the time of the initial operation. With this modified technique, the NAP can be performed on patients with ptotic breasts, allowing for improved cosmetic and oncological results.

This is a retrospective study of 45 female patients who underwent the modified NAP procedure followed by definitive reconstruction with perforator-based flaps.

Patients had a mean age of 46 years and a body mass index of 27 kg/m². Results demonstrate the procedure's efficacy in NAC preservation, with only 1 patient experiencing a minor hematoma. One patient developed skin flap necrosis affecting a portion of the areola, whereas another had unilateral nipple necrosis.

Overall, the modified NAP offers improved NAC survival compared with the standard nipple-sparing mastectomy and allows patients with ptotic breasts who may not be candidates for nipple-sparing mastectomy to undergo nipple preservation while maintaining oncological principles.