Dealing with the Displaced Nipple–Areola Complex in Macromastia Using a Superomedial Pedicle and Inverted T Pattern

In macromastia, especially in patients with a raised BMI, the nipple areola complex (NAC) may be displaced from the breast midline/meridian. This is poorly documented, and there is little published on surgical management. The aim of the study was to identify the incidence of displaced NAC in macromastia and discuss the management using the superomedial pedicle, by canting the vertical limbs of the inverted T/keyhole. The study also aimed to postulate a theory of pathogenesis. METHODS: The study is a retrospective review for a two-and-a-half year period. For study inclusion, the NAC had to be displaced 3 cm or more from the breast meridian. A superomedial pedicle was used with an inverted T pattern. The vertical limbs of the keyhole were canted medially for medially displaced NACs and laterally for laterally displaced NACs. RESULTS: Fifteen patients were identified: three with medial and 12 with laterally displaced NAC. Mean age was 35 years (range 21–61) with a mean BMI of 31 (range 27–37). The mean mass of tissue excised was 1158 g (range 330–1969 g). The mean follow up is 7 months (range 2–21 months). One patient suffered partial areola loss, and 2 patients had a breakdown at the angle of sorrow/inverted T junction. CONCLUSIONS: The displaced NAC is not uncommon in women with a raised BMI presenting for breast reduction. Canting the vertical limbs of the keyhole away from the deviated NAC yields satisfactory results in treating patients with a displaced NAC using a superomedial pedicle. A theory of possible pathogenesis is postulated; global attenuation of the breast footplate occurs, leading to lateral and inferior displacement of the NAC.