Posted by Dr. D on September 27, 2009, 8:28 pm, in reply to "Re: nipple sparing diep"
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Dear Lisa,
If your breast has a bit of droop, then an underneath incision is best to set us up for a breast lift and better ultimate shape. If no lift is required then a side incision is best to keep the incision off the breast with respect to appearance. Some surgeons do fold incisions but my personal opinion is that this incision is dangerous because it makes removal of breast tissue in the upper/outer part of the breast very very difficult, leaving the possibility of significant breast tissue left behind.
If the nipple is lost (only seen 1 or 2 times in 2 or 3 hundred), then the rest of the skin envelope is usually OK and an new nipple is made at a second stage. The reason for loss is usually trying it on a patient who is a poor candidate, ie. F cup breast with huge skin envelope and/or a patient who is a smoker. Tissue is not left under the nipple, it is "cored out" from underneath. Nipple projection can be preserved or restored with a small dermal graft under the preserve nipple envelope. Coring the nipple theoretically should affect viability but I haven't seen that it makes a difference and it is important to know the status of the tissue under the nipple.
I have had 4 patients who have had abnormal cells in the core specimen that we have had to go back and excise the nipple papilla a week after.
Yours,
Dr. D
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