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J Reconstr Microsurg
DOI: 10.1055/a-2616-4258
Original Article

Chronological Changes in Breast and Nipple Position After Autologous Reconstruction in an Asian Population

Suphalerk Lohasammakul
1   Department of Anatomy, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
2   Department of Plastic Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Republic of Korea
,
Johyun Yoon
2   Department of Plastic Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Republic of Korea
,
Chaiyawat Suppasilp
3   Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
,
Jin Sup Eom
2   Department of Plastic Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Republic of Korea
,
Hyun Ho Han 
2   Department of Plastic Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Republic of Korea
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Funding None.
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Abstract

Background

The breast shape changes between reconstructed and native breasts in autologous reconstruction, which is important to achieve symmetry. This study was conducted to clarify chronological changes in the shape and nipple position of the reconstructed breast compared with the contralateral breast in the Asian population.

Methods

Photographic assessments were conducted at baseline and during annual visits of patients who underwent immediate free flap breast reconstruction following unilateral nipple-sparing mastectomy at our institution between June 2017 and December 2019. Univariate and multivariate analyses were performed to identify factors associated with the change in shape and nipple position. This observation was most marked at 1-year postsurgery.

Results

Among the 170 patients (mean age, 48.04 ± 7.55 years), 164 (96.47%) had a deep inferior epigastric perforator flap and 8 (4.71%) required further surgery on the contralateral breast for correction of asymmetry. The chronological changes in the breast shape and nipple position significantly differed between the native and the reconstructed breast, with the latter showing a higher degree of retraction. Grading of breast ptosis (grades 0–2) and exposure to radiotherapy were associated with an increased degree of retraction.

Conclusion

Retraction may occur after free flap breast reconstruction, particularly in patients with ptosis or those receiving radiotherapy. These findings support careful planning, including volume adjustment and contralateral procedures. While based on an Asian population, the results may inform surgical decisions in similar patient groups.

Keywords

autologous breast reconstruction - DIEP - breast retraction - breast ptosis - contralateral symmetry procedure - nipple position

Supplementary Material



Publication History

Received: 01 May 2025

Accepted: 12 May 2025

Accepted Manuscript online:
21 May 2025

Article published online:
20 June 2025

© 2025. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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