Commentary on: The Effect of Implant Type on Nipple Position Geometry and Aesthetics Following Tissue Expander Reconstruction After Nipple Sparing Mastectomy

When oncologically appropriate, the benefits of nipple-sparing mastectomy are substantial. The skin envelope and conus of the breasts are retained thus affording a reconstruction with greater projection by way of a soft tissue envelope that is more redundant centrally.¹ By contrast a skin sparing mastectomy that results from the lenticular excision of the nipple-areola complex has less surface area centrally and "pushes back" to deform the shape of the breast implant. Subsequent nipple reconstruction requires an additional procedure, may have an inferior aesthetic outcome, and when a local flap to perform nipple reconstruction is used, recruits even more skin from the central breast making the envelope even tighter. While the shape, positional stability, and cohesivity of a breast implant all have a role in determining the shape of a reconstructed breast, they may be counteracted by the compliance, surface area, and shape of the soft tissue envelope. It is the interaction of implant and soft tissue envelope characteristics that determine the final shape and point of maximal projection of the reconstructed breast.