Patient’s proprioceptive remnants in nipple reconstruction planning

Abstract. – OBJECTIVE: The aim of this study is to demonstrate that for patients undergoing mastectomy the use of the proprioceptive memory represents a valid method to identify the perfect position of the nipple, which will be reconstructed on an operated breast. PATIENTS AND METHODS: Fifty-one patients undergoing breast reconstruction after unilateral Modified Radical Mastectomy or unilateral Skin Sparing Mastectomy were included in the study. All patients were asked to identify, while keeping their eyes closed, the mammary segment where they perceived their nipples, both on the reconstructed breast mound and on the contralateral breast. Sternal Notch-to-nipple distance (SN), Nipple-to-inframammary Fold distance (NF), Midclavicular line-tonipple distance (CN), the distance from the nipple to the chest Midline (NM), Anterior Axillary line-to-nipple distance (ZN) were measured on both breasts. The ideal position of the nipple to be reconstructed was evaluated using a geometric method based on the Pythagorean Theorem. RESULTS: A statistically significant correlation emerges between the distances measured from the anatomical landmarks of the chest to the point coinciding with the patient’s perception of the nipple on the reconstructed breast, and the distances measured from the same chest landmarks to the nipple on the contralateral native breast and to the nipple placed in the ideal position assessed with the geometric method. CONCLUSIONS: The patient’s proprioceptive memory of the nipple position can be useful to identify the exact place to reconstruct the nipple in breast reconstruction.