Techniques to Avoid Nipple and Flap Necrosis

When performing nipple-sparing mastectomy, there are multiple factors, which influence the risk of skin and nipple necrosis. Vascular anatomy: Maintaining blood supple to the anterior chest wall is crucial for a good outcome. Perforators from the internal thoracic vessels emerging from the intercostal space as well as the lateral thoracic vessels account for most of the blood of the anterior chest wall. Incisions: Incisions must be placed not only to maximize cosmetic outcome but must also be fashioned in such a way as to maintain blood supply to the nipple-areola complex. Elevating skin flaps: Elevating the mastectomy skin flaps in the correct surgical plane is also important in maintaining blood supply to the nipple-areola complex. I suggest that this plane is the interface of the breast parenchyma with the subcutaneous fat. Instruments and lighting: The careful use of electrosurgical devices prevents unintended damage to the arching subcutaneous vessels of the anterior chest wall. Because of smaller incisions, lighting is also crucial. Headlights or retractor-based lighting is recommended.