The Modified Nipple-Areola Preservation Procedure: An Evolution of the Technique After 10 Years of Experience.
- 1From the Department of Plastic Surgery, University of Texas Health Science Center, Houston, TX.
- 2My Houston Surgeons, Houston, TX.
- 3McGovern Medical School at The University of Texas Health Science Center, Houston, TX.
Abstract
Background
The nipple-areola preservation (NAP) procedure was introduced by the authors in 2015 as a way to increase the survivability of the native skin breast envelope and nipple-areola complex (NAC) in patients undergoing nipple-preserving mastectomies. By undermining the central mastectomy flap 2 weeks before the planned mastectomy, the skin and NAC benefit from the delay phenomenon, resulting in improved vascularity and survivability. In addition, the NAP allows the breast surgeon to identify subareolar malignant extension and sentinel lymph node status before mastectomy and reconstruction. After 10 years of experience with this procedure, the authors have streamlined the technique, resulting in fewer complications and allowing nipple repositioning at the time of the initial operation. With this modified technique, the NAP can be performed on patients with ptotic breasts, allowing for improved cosmetic and oncological results.Methods
This is a retrospective study of 45 female patients who underwent the modified NAP procedure followed by definitive reconstruction with perforator-based flaps.Results
Patients had a mean age of 46 years and a body mass index of 27 kg/m². Results demonstrate the procedure's efficacy in NAC preservation, with only 1 patient experiencing a minor hematoma. One patient developed skin flap necrosis affecting a portion of the areola, whereas another had unilateral nipple necrosis.Conclusions
Overall, the modified NAP offers improved NAC survival compared with the standard nipple-sparing mastectomy and allows patients with ptotic breasts who may not be candidates for nipple-sparing mastectomy to undergo nipple preservation while maintaining oncological principles.
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BibTeX
@article{mentz2026modified,
title = {{The Modified Nipple-Areola Preservation Procedure: An Evolution of the Technique After 10 Years of Experience.}},
author = {James A Mentz and Carlos A Martinez and Michelle Shen and Tarek M Zaghloul and Sean G Boutros},
journal = {Plastic and reconstructive surgery. Global open},
year = {2026},
month = oct,
doi = {10.1097/gox.0000000000008217},
url = {https://europepmc.org/article/MED/42921626},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - The Modified Nipple-Areola Preservation Procedure: An Evolution of the Technique After 10 Years of Experience.
AU - James A Mentz
AU - Carlos A Martinez
AU - Michelle Shen
AU - Tarek M Zaghloul
AU - Sean G Boutros
PY - 2026
DA - 2026/10/23
JO - Plastic and reconstructive surgery. Global open
DO - 10.1097/gox.0000000000008217
UR - https://europepmc.org/article/MED/42921626
AB - Background The nipple-areola preservation (NAP) procedure was introduced by the authors in 2015 as a way to increase the survivability of the native skin breast envelope and nipple-areola complex (NAC) in patients undergoing nipple-preserving mastectomies. By undermining the central mastectomy flap 2 weeks before the planned mastectomy, the skin and NAC benefit from the delay phenomenon, resulting in improved vascularity and survivability. In addition, the NAP allows the breast surgeon to identify subareolar malignant extension and sentinel lymph node status before mastectomy and reconstruction. After 10 years of experience with this procedure, the authors have streamlined the technique, resulting in fewer complications and allowing nipple repositioning at the time of the initial operation. With this modified technique, the NAP can be performed on patients with ptotic breasts, allowing for improved cosmetic and oncological results.Methods This is a retrospective study of 45 female patients who underwent the modified NAP procedure followed by definitive reconstruction with perforator-based flaps.Results Patients had a mean age of 46 years and a body mass index of 27 kg/m². Results demonstrate the procedure's efficacy in NAC preservation, with only 1 patient experiencing a minor hematoma. One patient developed skin flap necrosis affecting a portion of the areola, whereas another had unilateral nipple necrosis.Conclusions Overall, the modified NAP offers improved NAC survival compared with the standard nipple-sparing mastectomy and allows patients with ptotic breasts who may not be candidates for nipple-sparing mastectomy to undergo nipple preservation while maintaining oncological principles.
SN - 2169-7574
ER -