Factors predicting nipple asymmetry following therapeutic mammaplasty

Katherine Gale, Stephen McCulley, Douglas Macmillan

Nottingham City Hospital, Nottingham, UK

Background

Women who undergo bilateral therapeutic mammaplasty (BTM) usually have a modified breast reduction technique and radiotherapy on the cancer side. This may result in nipple asymmetry. The aim of this study was to assess nipple position during follow up after BTM and identify predictive factors for significant nipple asymmetry.

Methods

Standardised digital photographs taken > 1 year post treatment were used to determine the BRA score for nipple asymmetry and the direction of nipple deviation. Asymmetry was correlated with tumour location, mammaplasty technique, extent of resection, and axillary surgery.

Results

The average BRA value in 101 patients treated for unilateral breast cancer with BTM was 2.14 (range 0.2-6.1). BRA values were higher for upper pole cancers. For those women with nipple asymmetry, nipple deviation was usually in the direction of original tumour location. The extent of deviation was greatest for cancers in the upper half of the breast. Lateral deviation was predicted by axillary node clearance. There was no difference related to the extent of resection but vertical pattern mammaplasty produced better BRA scores than wise skin patterns (1.88 vs 2.33).

Conclusions

This study demonstrates that nipple asymmetry may be predicted in some patients undergoing BTM. Surgeons may wish to modify pre-operative planning to anticipate post-operative nipple position change.

Abstract from publication as appears in European Journal of Surgical Oncology. View file here.