“Inferior Repositioning of the High-Riding Nipple Using a Parenchymal-Based Flap”

Correction of the superiorly displaced nipple and areola complex (NAC) in patients who have undergone previous mastopexy or breast reduction presents as a difficult challenge. Previously described techniques are limited by restricted nipple mobility, an increased risk of vascular compromise, and potentially unfavorable aesthetic outcomes. A technique is presented that releases the superiorly malpositioned NAC from the surrounding breast flaps, keeping it attached to the underlying breast parenchyma. A vertically oriented skin incision is closed primarily, and the NAC is delivered into a new lower location situated at the apex of the breast mound. The new position of the NAC is easily accommodated as a result of the complete separation of the NAC from the surrounding breast parenchyma. The NAC maintains an adequate blood supply secondary to its remaining attachments to the underlying breast parenchyma and becomes freely mobile for delivery into a new location at any desired level. Using this strategy, an appropriate relationship between the position of the NAC and the breast mound is restored and well approximated skin closure above the NAC heals with a smooth contour with no dogear.