Nipple–Areola Complex Displacement After Reduction Mammoplasty: Association with the Volume of Resected Breast Tissue

Nipple–Areola Complex Displacement After Reduction Mammoplasty: Association with the Volume of Resected Breast Tissue | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Nipple–Areola Complex Displacement After Reduction Mammoplasty: Association with the Volume of Resected Breast Tissue Ezzatollah Rezaei, Omid Yazarlu, Ali Rahnama, Maryam Emadzadeh, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8797693/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background Reduction mammoplasty remains one of the most challenging surgery for many females in both physical and psychological aspects. The location of the nipple-areola complex (NAC) is a crucial factor in patient satisfaction and psychosocial function. To quantitatively assess the association between resected breast tissue volume and postoperative NAC displacement and to evaluate the predictive value of resection weight for clinically relevant nipple malposition. Methods In this cross-sectional study, thirty for women who were candidates for reduction mammoplasty surgery. Anatomical measurements, specifically the suprasternal notch to nipple (SSN-N) and nipple to inframammary fold (N-IMF) distances, were recorded preoperatively, intraoperatively (during surgical marking), and postoperatively at 1 week and 3–6 months. The collected data were entered into the SPSS software. Group comparisons were conducted via t-tests or Mann-Whitney U tests. The correlation between various variables was evaluated using the Spearman or Pearson correlation test. Receiver operating characteristic (ROC) curve analysis was employed to appraise the prognostic value of resection weight for nipple displacement. Statistical significance was defined as p < 0.05. Results In 64.3% of subjects whose resection weight was more than 500 grams, after surgery, the nipple was placed in a higher place than the previously determined place, while this percentage was equal to zero for those with resection weight less than 500 grams (P < 0.001). Conclusion Higher volumes of resected tissue in reduction mammoplasty are associated with increased nipple displacement and significant alterations in the N-IMF distance. These findings may assist surgeons in achieving more precise preoperative marking and improving the predictability of aesthetic results. Reduction mammoplasty nipple-areola complex nipple displacement resected tissue volume Figures Figure 1 Figure 2 Introduction Reduction mammoplasty (RM) is a true interface between reconstructive and aesthetic procedure to reduce overall breast volume while maintaining projection, function and vascularity [ 1 – 3 ]. Currently, regardless of the reduction technique, typically Wise-pattern or vertical scar, the goal is to also achieve a durable aesthetic postoperative outcomes with an anatomically appropriate NAC position [ 4 , 5 ]. Among all aesthetic parameters, the optimal position of the NAC remains a challenging to create desirable long-lasting results [ 6 , 7 ]. The NAC is a critical landmark influencing patient satisfaction and perceived surgical success [ 8 ]. Malposition of NAC, whether in the form of inferior migration, high-riding appearance, or distortion, is a recognized complications following RM and necessitate revision surgery [ 9 ]. Factors such as gravity, tissue quality, aging, pregnancy, and postoperative weight loss of breast projection and recurrent ptosis, even when intraoperative positioning is initially optimal [ 10 ]. Despite the high prevalence of RM, with over 500 000 procedures performed in 2021, NAC-related complications, including asymmetry, distortion and positional instability, scarring, continue to be reported with notable frequency [ 11 , 12 ]. While previous studies have investigated aesthetic outcomes and proposed predictive measurements in RM, emphasizing anatomical measurements and temporal shifts [ 13 ], and some have explored the influence of resected tissue weight on sensory outcomes [ 14 ], but the direct association between absolute quantitative tissue resection weight and the vertical shift of the postoperative NAC has not been calculated. Although several studies have investigated NAC positional changes and complications following reduction mammoplasty, and some have explored the influence of resected tissue weight on sensory outcomes, there remains limited evidence quantitatively linking resection weight to vertical NAC displacement. While postoperative NAC positional changes such as high-riding nipples have been described and managed in the literature following reduction mammoplasty, these studies predominantly focus on surgical technique and correction strategies rather than quantitative predictors such as resection weight [ 7 ]. Accordingly, this novel study was designed to focus on the correlation between the absolute weight of resected breast tissue and the precise distance of postoperative NAC displacement following MR. Postoperative NAC position was quantitatively assessed using two anatomical reference points: the inframammary fold and the sternal landmark. We hypothesized that increasing resection volumes, would be associated with greater inferior displacement of the NAC relative to both reference landmarks, indicating potential limitations of standard preoperative marking techniques in patients undergoing large-volume breast reduction. Methods Study design and participants This cross-sectional study with prospective postoperative follow-up included at least 50 women who were candidates for bilateral reduction mammoplasty, recruited using purposive sampling from among patients admitted to Ghaem Hospital, affiliated with Mashhad University of Medical Sciences. Inclusion and exclusion criteria Inclusion criteria were women aged 18 years or older with a clinical indication for bilateral reduction mammoplasty due to macromastia, and had no history of previous breast surgery or invasive breast procedures. All included patients provided informed consent for participation in the study and for the use of their clinical data. Exclusion criteria included any prior surgical intervention on the breasts, history of breast manipulation such as biopsy or sampling of a breast mass, unwillingness to participate in the study, and incomplete clinical or measurement data. At baseline, if the patients met the inclusion criteria, their demographic characteristics and relevant medical history were recorded. Patients with a history of previous breast surgery or any breast manipulation, including biopsy or mass sampling, were excluded from the study. To minimize measurement error and interobserver variability, all anthropometric measurements were performed by a single experienced plastic surgeon, and all subsequent measurements were conducted by the same examiner. Preoperative anthropometric measurements included: 1. the distance between the suprasternal notch and the nipple measured along the midclavicular line, and 2. the distance from the nipple to the inframammary fold. All measurements were obtained separately for the right and left breasts and recorded accordingly. Prior to surgery, these measurements were re-evaluated and recorded based on the preoperative markings, which also indicated the planned location of the new nipple. To minimize measurement bias, the new nipple was marked precisely on the breast meridian, defined as the line dividing the breast into two symmetrical halves. During surgery, the resected tissue weight of each breast was measured separately and recorded in grams. Patients were re-evaluated one week postoperatively for early postoperative complications, and the measurements were repeated and recorded. At the final follow-up, conducted 3–6 months after surgery, patients were re-examined, and all measurements were repeated. All collected data were then subjected to statistical analysis, and the results were reported accordingly. Statistical Analysis Data were entered into SPSS software for analysis. Descriptive statistics were presented using appropriate tables and graphs. Normality of data distribution was assessed prior to analysis. Pearson or Spearman correlation coefficients were used as appropriate. For comparison of quantitative variables between groups, independent Mann–Whitney U or t-test test was applied depending on data distribution. A p-value < 0.05 was measured statistically significant. Based on the study by Moio et al. [ 15 ], which reported a correlation coefficient of approximately 0.7 between resected tissue weight and the SSN–N distance, and considering a type I error of 0.01 and a power of 80%, the minimum required sample size was calculated to be 20 patients. To increase the robustness of the analysis, a total of 50 subjects were enrolled in our study. The standard normal deviation for α = Zα = 2.576 The standard normal deviation for β = Zβ = 0.842 C = 0.5 * ln[(1 + r)/(1-r)] = 0.867 Total sample size = N = [(Zα + Zβ)/C]2 + 3 = 19 Ethics Approval declaration section The study protocol was approved by the Ethics Committee of Mashhad University of Medical Sciences, with approval code: [IR.MUMS.MEDICAL.REC.1399.246]. Written informed consent was gotten from all subjects former to enrollment, and the study was directed in accordance with the Declaration of Helsinki. Clinical trial number: not applicable. Results A total of 34 patients, comprising 68 breasts, were included in the final statistical analysis after excluding patients who withdrew from the study or were unavailable for postoperative follow-up. The patients’ ages ranged from 23 to 55 years, with a mean age of 38.59 ± 6.98 years. The prevalence of concomitant diseases in the patients’ medical history is presented in Table 1 . Of the 34 patients included, 22 (64.7%) had no history of comorbid conditions, whereas 12 patients (35.3%) had at least one underlying disease. As previous breast surgery was an exclusion criterion, none of the patients had a history of prior breast surgery; therefore, this factor did not act as a potential confounder. Table 1 Mean measurements of all breasts based on preoperative data and intraoperative marking one week after the operation and 3–6 months after the operation Timeline Variable Average Before operation suprasternal notch to nipple distance (SSN-N) 32.55 ± 4.31 intraoperative marking Distance from the suprasternal notch to the nipple (SSN-N) 21.42 ± 1.36 One week after surgery Distance from the suprasternal notch to the nipple (SSN-N) 21.00 ± 1.30 Three-six months after surgery Distance from the suprasternal notch to the nipple (SSN-N) 21.22 ± 1.40 Timeline Variable Average Before operation Distance from nipple to the inframammary fold (N-IMF) 14.66 ± 3.35 One week after surgery Distance from nipple to the inframammary fold (N-IMF) 9.71 ± 1.06 Three-six months after surgery Distance from nipple to the inframammary fold (N-IMF) 10.19 ± 1.16 Among the study population, 8 patients (23.5%) were nulliparous with no history of pregnancy or childbirth, while 26 patients (76.5%) had a history of childbirth. Regarding the surgical technique, reduction mammoplasty was performed using the superior pedicle technique in 5 patients (14.7%), the superomedial or medial pedicle technique in 26 patients (76.5%), and the free nipple graft technique in 3 patients (8.8%). Postoperative complications were observed in 9 patients (26.5%). The most common complication was wound dehiscence, occurring in 3 patients (8.8%). Other complications included hematoma, surgical site infection, and loss of nipple sensation, each reported in 2 patients (5.9%). The mean preoperative SSN–N and N–IMF distances were 32.55 ± 4.31 cm and 14.66 ± 3.35 cm, respectively. Based on intraoperative preoperative markings, the planned new nipple position was located at a mean distance of 21.42 ± 1.36 cm from the suprasternal notch. At one week postoperatively, the mean SSN–N distance was 21.00 ± 1.30 cm, indicating a significant reduction compared with preoperative measurements (P < 0.001). The mean N–IMF distance at one week after surgery was 9.71 ± 1.06 cm. At the 3–6-month follow-up, the mean SSN–N distance was 21.22 ± 1.40 cm, which was significantly lower than the intraoperative marking measurement (P = 0.002), while showing a slight increase compared with the one-week postoperative measurement (P = 0.003). At the same follow-up interval, the mean N–IMF distance was 10.19 ± 1.16 cm, representing an increase of 0.80 ± 0.49 cm compared with the one-week postoperative measurement (P < 0.001). For ease of comparison, the mean SSN–N and N–IMF distances at different time points are summarized in Table 2 . Table 2 Approximate amount of breast resection weight based on grams Variable Average The least The most Breast resection weight 917.13 ± 444.99 250 1950 Based on Pearson correlation analysis and corresponding P-values, the relationship between breast tissue resection weight and changes in SSN–N distance was evaluated. The correlation coefficient between resection weight and postoperative changes in the SSN–N distance was − 0.343, indicating a weak to moderate inverse correlation. This finding suggests that greater resection weight was associated with a greater reduction in the SSN–N distance over the postoperative period and at follow-up, and this correlation was statistically significant. Furthermore, analysis of the change in the N–IMF distance between one week and 3–6 months after surgery revealed a Pearson correlation coefficient of 0.373, demonstrating a weak to moderate direct correlation between breast resection weight and the increase in this distance. This association was also statistically significant. In addition, evaluation of changes in the SSN–N distance between the surgeon’s intraoperative marking and the 3–6-month postoperative follow-up showed that, among the 68 breasts evaluated, 19 breasts exhibited no change, 13 breasts demonstrated an increase, and 36 breasts showed a decrease in the SSN–N distance. As shown in Table 3 , among the 32 breasts in which the SSN–N distance either remained unchanged or increased between intraoperative marking and the 3–6-month follow-up, the mean resection weight was 765 g. In contrast, in the 36 breasts in which the SSN–N distance decreased over the same interval, the mean resection weight was significantly higher, at 1051 g (P = 0.008). Table 3 Relationship between the breast resection weight and the difference between the distance between the nipple and the suprasternal notch and the inframammary fold in the measurements after the operation and three to six months follow-up based on the Pearson correlation test and the P-value Variable Difference in N-IMF distance one week after surgery and three to six months follow-up Difference in SSN-N distance after surgery and three-six months follow-up after surgery Breast resection weight Pearson Correlation 0.373 -0.343 Sig. (2-tailed) 0.002 0.004 N 68 68 Regarding changes in N–IMF distance between the one-week postoperative measurement and the 3–6-month follow-up, breasts in which this distance remained unchanged or decreased (24 breasts) had a mean resection weight of 761 g, whereas breasts demonstrating an increase in the N–IMF distance had a higher mean resection weight of 1002 g; however, this difference did not reach statistical significance (P = 0.053). We evaluated whether breast resection weight could predict superior displacement of the nipple position. Receiver operating characteristic (ROC) curve analysis demonstrated an area under the curve (AUC) of 0.68, indicating fair discriminative ability (P = 0.008). An AUC value of 0.68 suggests acceptable predictive performance of resection weight for postoperative nipple position changes. As illustrated in Fig. 1 , after categorizing resection weight into two groups (≤ 500 g and > 500 g), it was observed that 64.3% of breasts with a resection weight greater than 500 g exhibited postoperative superior displacement of the nipple relative to the preoperatively determined position. In contrast, no cases of superior nipple displacement were observed among breasts with a resection weight of 500 g or less (P < 0.001). Discussion One of the common challenges faced by plastic surgeons in reduction mammoplasty is postoperative and long-term changes in breast tissue configuration and parenchymal position, as well as alterations in the position of the NAC. Representative examples of these changes include bottoming-out of the lower pole of the breast [ 15 ] and the high-riding nipple phenomenon, in which the NAC is positioned higher than the location initially marked by the surgeon [ 16 ]. Over the years, more than 50 surgical techniques have been developed and refined in an effort to address these complications and improve long-term aesthetic outcomes [ 17 ]. Various methods have also been proposed to determine the optimal intraoperative marking of the NAC in order to achieve stable postoperative results [ 18 , 19 ]. Accurate NAC positioning is particularly critical in patients with breast asymmetry, where even minor positional discrepancies may be more noticeable and clinically relevant [ 20 ]. Correction of benign nipple malposition remains a challenging aspect of breast reduction surgery, and multiple strategies have been described in the literature to address this issue [ 21 ]. In clinical practice, experienced plastic surgeons often intentionally mark the new nipple position slightly lower in patients with a long suprasternal notch–to–nipple distance and in cases of macromastia where a large volume of breast tissue is expected to be resected. This empirical adjustment is commonly applied in reduction mammoplasty for large breasts to compensate for postoperative tissue settling and positional changes over time. Based on these clinical observations, the present study aimed to systematically evaluate the relationship between postoperative displacement of the nipple–areola complex and breast resection weight. Although several previous studies have examined nipple position, breast measurements, and surgical outcomes using different methodologies, to the best of our knowledge, none have specifically investigated the association between the magnitude of NAC displacement following reduction mammoplasty and the weight of resected breast tissue in this manner. Compared with intraoperative marking, the SSN–N distance demonstrated a mean reduction at the 3–6-month postoperative follow-up, which was statistically significant (P = 0.002). The average magnitude of this reduction in the present study was − 0.21 cm. In contrast, Altuntaş et al. reported a substantially greater mean reduction of − 1.75 cm in the SSN–N distance in their analysis of 96 breasts, with a longer mean follow-up period of 19 months [ 10 ]. Differences in sample size, follow-up duration, and surgical technique may partly account for the discrepancy between these findings. Similarly, Ozan Bitik et al., who evaluated 75 breasts with a 2-year follow-up, observed that although the nipple position was approximately 1.2 cm higher at the early postoperative visit compared with intraoperative marking, no significant change in nipple position was detected during the 2-year follow-up period [ 22 ]. In the study by Jamil Ahmad et al., which evaluated 49 patients with a 4-year follow-up, the nipple position was reported to be 1.3 cm higher on average five days after surgery and 1.0 cm higher at the 4-year follow-up compared with the intraoperative marking [ 23 ]. These findings support the concept of elastic recoil of breast tissue following surgery, suggesting that the final nipple position tends to be, on average, higher than the initially planned intraoperative marking. Another aspect evaluated in the present study was the change in the N–IMF distance between the measurement obtained one week postoperatively and that obtained at the 3–6-month follow-up. Another finding of the present study was a significant increase in the N–IMF distance between the measurement obtained one week postoperatively and that obtained at the 3–6-month follow-up, with a mean increase of 0.49 cm. This observation is consistent with clinical findings commonly noted by plastic surgeons during long-term postoperative evaluations, in which inferior displacement and settling of breast tissue may occur over time. Several technical modifications have been proposed to address this phenomenon and reduce postoperative lower-pole descent, including the vertical scar technique, which aims to improve breast projection and maintain long-term shape following reduction mammoplasty. Another finding of the present study was a significant increase in the N–IMF distance between the measurement obtained one week postoperatively and that obtained at the 3–6-month follow-up, with a mean increase of 0.49 cm. This observation is consistent with clinical findings commonly reported by plastic surgeons during long-term postoperative follow-up, in which inferior displacement and progressive settling of breast tissue may occur over time. Several technical modifications have been proposed to address this phenomenon and reduce postoperative lower-pole descent, including the vertical scar technique, which aims to enhance breast projection and preserve long-term breast shape following reduction mammoplasty. Further support for these findings is provided by the observed relationship between changes in the N–IMF distance and breast resection weight, which demonstrated a direct and statistically significant correlation (r = 0.373). The absolute magnitude of this correlation was comparable to that observed for changes in the SSN–N distance. In the present study, after stratifying resection weight into two categories (≤ 500 g and > 500 g), it was found that 64.3% of breasts with a resection weight greater than 500 g exhibited postoperative superior displacement of the nipple relative to the preoperatively determined position, whereas no cases of superior nipple displacement were observed among breasts with a resection weight of 500 g or less (P < 0.001). In clinical practice, many experienced plastic surgeons intentionally position the new nipple slightly lower during preoperative marking in patients with large breasts. Based on the findings of the present study, it may be prudent to exercise additional caution in intraoperative nipple marking when the estimated breast resection weight exceeds 500 g. However, to establish a more precise predictive model or a standardized guideline for this purpose, further studies with larger sample sizes and longer follow-up periods are warranted. In cases of breast asymmetry, the results of the present study may also be of practical value. Differences in resected weight between the two breasts could be considered during preoperative planning to optimize nipple positioning and improve postoperative symmetry. Limitations The study has limitations. The single-center design, small sample size, and involvement of a limited number of surgeons may limited the generalizability of the findings. In addition, the use of different surgical techniques and the relatively short follow-up period should be considered when interpreting the results. Future multicenter studies with larger sample sizes, longer follow-up durations, and technique-specific analyses are warranted to further validate these findings. Conclusion Based on the findings of the present study, breasts with a greater resection weight appear to be more prone to postoperative superior displacement of the nipple relative to the surgeon’s initial intraoperative marking. Awareness of this association may assist plastic surgeons in refining intraoperative nipple positioning, particularly in cases in which the estimated resection weight exceeds 500 g (Fig. 2 ). Nevertheless, further studies are required before definitive recommendations can be established. Declarations Conflict of interest : none. Funding: none. Author Contribution E.R. and O.Y. contributed to conceptualization and study design.A.R. and M.Gh. were responsible for data collection and investigation.M. E. performed the statistical analysis and data interpretation.A.R. drafted the manuscript.All authors contributed to manuscript revision, read, and approved the final version. References Ran R et al (2025) Risk factors for complications after reduction mammaplasty: a systematic review and meta-analysis. Eur J Med Res 30(1):440 Wang AY et al (2025) Nerve Blocks in Reduction Mammaplasty: A Systematic Review and Meta-Analysis of Pain Outcomes. J Surg Res 315:128–138 Sharma S, Dhakad A (2025) Choosing the Right Pedicle for Reduction Mammoplasty: Balancing Vascularity and Aesthetics. Int J Aesthetic Plast Surg 1(2):131–139 Godwin Y et al (2014) A comparison of the patient and surgeon opinion on the long-term aesthetic outcome of reduction mammaplasty: have we improved over 15 years? J Plast Reconstr Aesthetic Surg 67(7):932–938 Sachs D, Hattingh G, Szymanski KD (2025) Breast reduction. StatPearls [Internet]. StatPearls Publishing Lewin R et al (2016) The aesthetically ideal position of the nipple–areola complex on the breast. Aesthetic Plast Surg 40(5):724–732 Weale R, Javed MU (2025) Management of High-Riding Nipple-Areola Complex: A Systematic Review of Its Prevention and Management. Aesthetic Plastic Surgery, pp 1–19 Swanson E (2018) Photometric evaluation of long-term changes in breast shape after breast augmentation and vertical mammaplasty. Plast Reconstr Surgery–Global Open 6(6):e1844 Schlittler F et al (2018) What is the incidence of implant malpositioning and revision surgery after orbital repair? J Oral Maxillofac Surg 76(1):146–153 Altuntaş ZK et al (2015) Long-term changes in nipple-areolar complex position and inferior pole length in superomedial pedicle inverted ‘t’scar reduction mammaplasty. Aesthetic plastic surgery, 39(3): pp. 325–330 ISAPS (2019) International Survey on aesthetic/cosmetic procedures performed in 2018. International Society of Aesthetic Plastic Surgery Palve J et al (2022) Predictive risk factors of complications in reduction mammoplasty—analysis of three different pedicles. Gland Surg 11(8):1309 Alnabi A et al (2023) Prospective observational study of Nipple–Areola Complex Position post breast reduction. Wits J Clin Med 5(1):19–24 Watfa W et al (2022) Long-term evaluation of Nipple–Areolar complex changes in inferior versus superomedial pedicle reduction mammoplasty: A comparative study. J Plast Reconstr Aesthetic Surg 75(3):1179–1186 Meshulam-Derazon S et al (2009) Large-volume breast reduction: long-term results. Scand J Plast Reconstr Surg Hand Surg 43(2):65–70 Spear SL, Albino FP, Al-Attar A (2013) Classification and management of the postoperative, high-riding nipple. Plast Reconstr Surg 131(6):1413–1421 Nahabedian M (2018) Reduction mammaplasty with inverted-T techniques. Plast Surg E-Book 5:136–159 Gulyás G (2004) Marking the position of the nipple-areola complex for mastopexy and breast reduction surgery. Plast Reconstr Surg 113(7):2085–2090 Khan HA, Bayat A (2008) A geometric method for nipple localization. Can J Plast Surg 16(1):45–47 de Vita R et al (2019) Breast asymmetry, classification, and algorithm of treatment: our experience. Aesthetic Plast Surg 43(6):1439–1450 Colwell AS, May JW Jr, Slavin SA (2007) Lowering the postoperative high-riding nipple. Plast Reconstr Surg 120(3):596–599 Bitik O, Uzun H (2016) Analysis of lower breast pole length and nipple–areola complex position following superior pedicle, short horizontal scar breast reduction. Aesthetic Plast Surg 40(5):690–698 Ahmad J, Lista F (2008) Vertical scar reduction mammaplasty: the fate of nipple-areola complex position and inferior pole length. Plast Reconstr Surg 121(4):1084–1091 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 11 Apr, 2026 Reviews received at journal 14 Mar, 2026 Reviewers agreed at journal 13 Mar, 2026 Reviewers invited by journal 24 Feb, 2026 Editor assigned by journal 11 Feb, 2026 Submission checks completed at journal 11 Feb, 2026 First submitted to journal 05 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8797693","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":596457070,"identity":"3a1a4b17-9a9c-4321-bd52-70e090abd5f2","order_by":0,"name":"Ezzatollah Rezaei","email":"","orcid":"","institution":"Mashhad University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Ezzatollah","middleName":"","lastName":"Rezaei","suffix":""},{"id":596457072,"identity":"4bda797a-8356-47dd-866d-f0534187183d","order_by":1,"name":"Omid Yazarlu","email":"","orcid":"","institution":"Mashhad University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Omid","middleName":"","lastName":"Yazarlu","suffix":""},{"id":596457074,"identity":"ea80ad4c-b2de-46e8-a6fb-1f650d06c6e6","order_by":2,"name":"Ali Rahnama","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABBElEQVRIiWNgGAWjYDCCAzxsYBLM/lABJJmZG4jWwnhwxhmQFkbitICYzId520A0AS18x88ee/Dj1x0Z/tntDw7wzquN5m8HavlRsQ2nFskzeemGvX3PeCTunDE4ILnteO6Mw4wNjD1nbuPUYnAgx0yCt+cwD8ONHIYDhtuO5TYAtTAztuHRcv6NmeRfoBb5G+kPDiTOOZY7n6CWGzlm0jw/DvMY3EgwOHCwoSZ3AyEtkjfepRvLNhzmMbyRY3Cw4diB3I1ALQfx+YXvfO6xh2/+HLaXu5H++POfmrrceecPH3zwowK3FjBgbIMzD4PJA/jVg8AfOKuOsOJRMApGwSgYcQAAeOBsC7f9sYUAAAAASUVORK5CYII=","orcid":"","institution":"Mashhad University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Ali","middleName":"","lastName":"Rahnama","suffix":""},{"id":596457075,"identity":"3154ae4d-e61c-4c85-a2a7-6f38601039d8","order_by":3,"name":"Maryam Emadzadeh","email":"","orcid":"","institution":"Mashhad University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Maryam","middleName":"","lastName":"Emadzadeh","suffix":""},{"id":596457078,"identity":"9112cda0-2439-4cb5-ae15-6da3df57077a","order_by":4,"name":"Mahdi Ghoncheh","email":"","orcid":"","institution":"Mashhad University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Mahdi","middleName":"","lastName":"Ghoncheh","suffix":""}],"badges":[],"createdAt":"2026-02-05 13:38:34","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8797693/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8797693/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":103597093,"identity":"c866bfda-51de-4ec1-b823-00980f27a843","added_by":"auto","created_at":"2026-02-27 13:23:00","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":50655,"visible":true,"origin":"","legend":"\u003cp\u003eROC curve showing the predictive value of resection weight for postoperative nipple elevation (AUC = 0.68, P = 0.008). A resection weight \u0026gt;500 g was associated with a higher postoperative nipple position compared with \u0026lt;500 g (P \u0026lt; 0.001).\u003c/p\u003e","description":"","filename":"figuree1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8797693/v1/c013c0676bc0baaf7faaf02c.jpg"},{"id":104398452,"identity":"909b4d57-9f45-426e-af42-3a19b0b486dd","added_by":"auto","created_at":"2026-03-11 12:02:26","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":11754,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of the conventional standard nipple position and the newly proposed nipple position. The upper mark indicates the standard position, while the lower mark represents the new nipple position based on our research. The new position is located 1 cm inferior to the standard method and is applied in patients with breast weight more than 500 g.\u003c/p\u003e","description":"","filename":"figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8797693/v1/561ae62770358d27386d01e1.jpg"},{"id":104407652,"identity":"f2088f71-a1a8-4db5-b918-9589af99cf1e","added_by":"auto","created_at":"2026-03-11 12:39:26","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":700771,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8797693/v1/2850fd61-4269-46b1-a1b8-7825bdc2aa5f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Nipple–Areola Complex Displacement After Reduction Mammoplasty: Association with the Volume of Resected Breast Tissue","fulltext":[{"header":"Introduction","content":"\u003cp\u003eReduction mammoplasty (RM) is a true interface between reconstructive and aesthetic procedure to reduce overall breast volume while maintaining projection, function and vascularity [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Currently, regardless of the reduction technique, typically Wise-pattern or vertical scar, the goal is to also achieve a durable aesthetic postoperative outcomes with an anatomically appropriate NAC position [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Among all aesthetic parameters, the optimal position of the NAC remains a challenging to create desirable long-lasting results [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe NAC is a critical landmark influencing patient satisfaction and perceived surgical success [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Malposition of NAC, whether in the form of inferior migration, high-riding appearance, or distortion, is a recognized complications following RM and necessitate revision surgery [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Factors such as gravity, tissue quality, aging, pregnancy, and postoperative weight loss of breast projection and recurrent ptosis, even when intraoperative positioning is initially optimal [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Despite the high prevalence of RM, with over 500 000 procedures performed in 2021, NAC-related complications, including asymmetry, distortion and positional instability, scarring, continue to be reported with notable frequency [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. While previous studies have investigated aesthetic outcomes and proposed predictive measurements in RM, emphasizing anatomical measurements and temporal shifts [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], and some have explored the influence of resected tissue weight on sensory outcomes [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], but the direct association between absolute quantitative tissue resection weight and the vertical shift of the postoperative NAC has not been calculated. Although several studies have investigated NAC positional changes and complications following reduction mammoplasty, and some have explored the influence of resected tissue weight on sensory outcomes, there remains limited evidence quantitatively linking resection weight to vertical NAC displacement. While postoperative NAC positional changes such as high-riding nipples have been described and managed in the literature following reduction mammoplasty, these studies predominantly focus on surgical technique and correction strategies rather than quantitative predictors such as resection weight [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAccordingly, this novel study was designed to focus on the correlation between the absolute weight of resected breast tissue and the precise distance of postoperative NAC displacement following MR. Postoperative NAC position was quantitatively assessed using two anatomical reference points: the inframammary fold and the sternal landmark. We hypothesized that increasing resection volumes, would be associated with greater inferior displacement of the NAC relative to both reference landmarks, indicating potential limitations of standard preoperative marking techniques in patients undergoing large-volume breast reduction.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and participants\u003c/h2\u003e \u003cp\u003eThis cross-sectional study with prospective postoperative follow-up included at least 50 women who were candidates for bilateral reduction mammoplasty, recruited using purposive sampling from among patients admitted to Ghaem Hospital, affiliated with Mashhad University of Medical Sciences.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eInclusion and exclusion criteria\u003c/h3\u003e\n\u003cp\u003eInclusion criteria were women aged 18 years or older with a clinical indication for bilateral reduction mammoplasty due to macromastia, and had no history of previous breast surgery or invasive breast procedures. All included patients provided informed consent for participation in the study and for the use of their clinical data. Exclusion criteria included any prior surgical intervention on the breasts, history of breast manipulation such as biopsy or sampling of a breast mass, unwillingness to participate in the study, and incomplete clinical or measurement data. At baseline, if the patients met the inclusion criteria, their demographic characteristics and relevant medical history were recorded. Patients with a history of previous breast surgery or any breast manipulation, including biopsy or mass sampling, were excluded from the study. To minimize measurement error and interobserver variability, all anthropometric measurements were performed by a single experienced plastic surgeon, and all subsequent measurements were conducted by the same examiner.\u003c/p\u003e \u003cp\u003ePreoperative anthropometric measurements included: 1. the distance between the suprasternal notch and the nipple measured along the midclavicular line, and 2. the distance from the nipple to the inframammary fold. All measurements were obtained separately for the right and left breasts and recorded accordingly. Prior to surgery, these measurements were re-evaluated and recorded based on the preoperative markings, which also indicated the planned location of the new nipple. To minimize measurement bias, the new nipple was marked precisely on the breast meridian, defined as the line dividing the breast into two symmetrical halves. During surgery, the resected tissue weight of each breast was measured separately and recorded in grams. Patients were re-evaluated one week postoperatively for early postoperative complications, and the measurements were repeated and recorded. At the final follow-up, conducted 3\u0026ndash;6 months after surgery, patients were re-examined, and all measurements were repeated. All collected data were then subjected to statistical analysis, and the results were reported accordingly.\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eData were entered into SPSS software for analysis. Descriptive statistics were presented using appropriate tables and graphs. Normality of data distribution was assessed prior to analysis. Pearson or Spearman correlation coefficients were used as appropriate. For comparison of quantitative variables between groups, independent Mann\u0026ndash;Whitney U or t-test test was applied depending on data distribution. A p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was measured statistically significant.\u003c/p\u003e \u003cp\u003eBased on the study by Moio et al. [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], which reported a correlation coefficient of approximately 0.7 between resected tissue weight and the SSN\u0026ndash;N distance, and considering a type I error of 0.01 and a power of 80%, the minimum required sample size was calculated to be 20 patients. To increase the robustness of the analysis, a total of 50 subjects were enrolled in our study.\u003c/p\u003e \u003cp\u003eThe standard normal deviation for α\u0026thinsp;=\u0026thinsp;Zα\u0026thinsp;=\u0026thinsp;2.576\u003c/p\u003e \u003cp\u003eThe standard normal deviation for β\u0026thinsp;=\u0026thinsp;Zβ\u0026thinsp;=\u0026thinsp;0.842\u003c/p\u003e \u003cp\u003eC\u0026thinsp;=\u0026thinsp;0.5 * ln[(1\u0026thinsp;+\u0026thinsp;r)/(1-r)]\u0026thinsp;=\u0026thinsp;0.867\u003c/p\u003e \u003cp\u003eTotal sample size\u0026thinsp;=\u0026thinsp;N = [(Zα\u0026thinsp;+\u0026thinsp;Zβ)/C]2\u0026thinsp;+\u0026thinsp;3\u0026thinsp;=\u0026thinsp;19\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eEthics Approval declaration section\u003c/h3\u003e\n\u003cp\u003e The study protocol was approved by the Ethics Committee of Mashhad University of Medical Sciences, with approval code: [IR.MUMS.MEDICAL.REC.1399.246]. Written informed consent was gotten from all subjects former to enrollment, and the study was directed in accordance with the Declaration of Helsinki.\u003c/p\u003e \u003cp\u003eClinical trial number: not applicable.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 34 patients, comprising 68 breasts, were included in the final statistical analysis after excluding patients who withdrew from the study or were unavailable for postoperative follow-up. The patients\u0026rsquo; ages ranged from 23 to 55 years, with a mean age of 38.59\u0026thinsp;\u0026plusmn;\u0026thinsp;6.98 years. The prevalence of concomitant diseases in the patients\u0026rsquo; medical history is presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Of the 34 patients included, 22 (64.7%) had no history of comorbid conditions, whereas 12 patients (35.3%) had at least one underlying disease. As previous breast surgery was an exclusion criterion, none of the patients had a history of prior breast surgery; therefore, this factor did not act as a potential confounder.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMean measurements of all breasts based on preoperative data and intraoperative marking one week after the operation and 3\u0026ndash;6 months after the operation\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTimeline\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAverage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBefore operation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003esuprasternal notch to nipple distance (SSN-N)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32.55\u0026thinsp;\u0026plusmn;\u0026thinsp;4.31\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eintraoperative marking\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDistance from the suprasternal notch to the nipple (SSN-N)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.42\u0026thinsp;\u0026plusmn;\u0026thinsp;1.36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOne week after surgery\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDistance from the suprasternal notch to the nipple (SSN-N)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.00\u0026thinsp;\u0026plusmn;\u0026thinsp;1.30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eThree-six months after surgery\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDistance from the suprasternal notch to the nipple (SSN-N)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.22\u0026thinsp;\u0026plusmn;\u0026thinsp;1.40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTimeline\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eVariable\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAverage\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBefore operation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDistance from nipple to the inframammary fold (N-IMF)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.66\u0026thinsp;\u0026plusmn;\u0026thinsp;3.35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOne week after surgery\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDistance from nipple to the inframammary fold (N-IMF)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.71\u0026thinsp;\u0026plusmn;\u0026thinsp;1.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eThree-six months after surgery\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDistance from nipple to the inframammary fold (N-IMF)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.19\u0026thinsp;\u0026plusmn;\u0026thinsp;1.16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAmong the study population, 8 patients (23.5%) were nulliparous with no history of pregnancy or childbirth, while 26 patients (76.5%) had a history of childbirth. Regarding the surgical technique, reduction mammoplasty was performed using the superior pedicle technique in 5 patients (14.7%), the superomedial or medial pedicle technique in 26 patients (76.5%), and the free nipple graft technique in 3 patients (8.8%). Postoperative complications were observed in 9 patients (26.5%). The most common complication was wound dehiscence, occurring in 3 patients (8.8%). Other complications included hematoma, surgical site infection, and loss of nipple sensation, each reported in 2 patients (5.9%). The mean preoperative SSN\u0026ndash;N and N\u0026ndash;IMF distances were 32.55\u0026thinsp;\u0026plusmn;\u0026thinsp;4.31 cm and 14.66\u0026thinsp;\u0026plusmn;\u0026thinsp;3.35 cm, respectively. Based on intraoperative preoperative markings, the planned new nipple position was located at a mean distance of 21.42\u0026thinsp;\u0026plusmn;\u0026thinsp;1.36 cm from the suprasternal notch. At one week postoperatively, the mean SSN\u0026ndash;N distance was 21.00\u0026thinsp;\u0026plusmn;\u0026thinsp;1.30 cm, indicating a significant reduction compared with preoperative measurements (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The mean N\u0026ndash;IMF distance at one week after surgery was 9.71\u0026thinsp;\u0026plusmn;\u0026thinsp;1.06 cm. At the 3\u0026ndash;6-month follow-up, the mean SSN\u0026ndash;N distance was 21.22\u0026thinsp;\u0026plusmn;\u0026thinsp;1.40 cm, which was significantly lower than the intraoperative marking measurement (P\u0026thinsp;=\u0026thinsp;0.002), while showing a slight increase compared with the one-week postoperative measurement (P\u0026thinsp;=\u0026thinsp;0.003). At the same follow-up interval, the mean N\u0026ndash;IMF distance was 10.19\u0026thinsp;\u0026plusmn;\u0026thinsp;1.16 cm, representing an increase of 0.80\u0026thinsp;\u0026plusmn;\u0026thinsp;0.49 cm compared with the one-week postoperative measurement (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). For ease of comparison, the mean SSN\u0026ndash;N and N\u0026ndash;IMF distances at different time points are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eApproximate amount of breast resection weight based on grams\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAverage\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThe least\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eThe most\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBreast resection weight\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e917.13\u0026thinsp;\u0026plusmn;\u0026thinsp;444.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e250\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1950\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eBased on Pearson correlation analysis and corresponding P-values, the relationship between breast tissue resection weight and changes in SSN\u0026ndash;N distance was evaluated. The correlation coefficient between resection weight and postoperative changes in the SSN\u0026ndash;N distance was \u0026minus;\u0026thinsp;0.343, indicating a weak to moderate inverse correlation. This finding suggests that greater resection weight was associated with a greater reduction in the SSN\u0026ndash;N distance over the postoperative period and at follow-up, and this correlation was statistically significant.\u003c/p\u003e \u003cp\u003eFurthermore, analysis of the change in the N\u0026ndash;IMF distance between one week and 3\u0026ndash;6 months after surgery revealed a Pearson correlation coefficient of 0.373, demonstrating a weak to moderate direct correlation between breast resection weight and the increase in this distance. This association was also statistically significant. In addition, evaluation of changes in the SSN\u0026ndash;N distance between the surgeon\u0026rsquo;s intraoperative marking and the 3\u0026ndash;6-month postoperative follow-up showed that, among the 68 breasts evaluated, 19 breasts exhibited no change, 13 breasts demonstrated an increase, and 36 breasts showed a decrease in the SSN\u0026ndash;N distance. As shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, among the 32 breasts in which the SSN\u0026ndash;N distance either remained unchanged or increased between intraoperative marking and the 3\u0026ndash;6-month follow-up, the mean resection weight was 765 g. In contrast, in the 36 breasts in which the SSN\u0026ndash;N distance decreased over the same interval, the mean resection weight was significantly higher, at 1051 g (P\u0026thinsp;=\u0026thinsp;0.008).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRelationship between the breast resection weight and the difference between the distance between the nipple and the suprasternal notch and the inframammary fold in the measurements after the operation and three to six months follow-up based on the Pearson correlation test and the P-value\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDifference in N-IMF distance one week after surgery and three to six months follow-up\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDifference in SSN-N distance after surgery and three-six months follow-up after surgery\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBreast resection weight\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePearson Correlation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.373\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.343\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSig. (2-tailed)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eRegarding changes in N\u0026ndash;IMF distance between the one-week postoperative measurement and the 3\u0026ndash;6-month follow-up, breasts in which this distance remained unchanged or decreased (24 breasts) had a mean resection weight of 761 g, whereas breasts demonstrating an increase in the N\u0026ndash;IMF distance had a higher mean resection weight of 1002 g; however, this difference did not reach statistical significance (P\u0026thinsp;=\u0026thinsp;0.053). We evaluated whether breast resection weight could predict superior displacement of the nipple position. Receiver operating characteristic (ROC) curve analysis demonstrated an area under the curve (AUC) of 0.68, indicating fair discriminative ability (P\u0026thinsp;=\u0026thinsp;0.008). An AUC value of 0.68 suggests acceptable predictive performance of resection weight for postoperative nipple position changes.\u003c/p\u003e \u003cp\u003eAs illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, after categorizing resection weight into two groups (\u0026le;\u0026thinsp;500 g and \u0026gt;\u0026thinsp;500 g), it was observed that 64.3% of breasts with a resection weight greater than 500 g exhibited postoperative superior displacement of the nipple relative to the preoperatively determined position. In contrast, no cases of superior nipple displacement were observed among breasts with a resection weight of 500 g or less (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOne of the common challenges faced by plastic surgeons in reduction mammoplasty is postoperative and long-term changes in breast tissue configuration and parenchymal position, as well as alterations in the position of the NAC. Representative examples of these changes include bottoming-out of the lower pole of the breast [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] and the high-riding nipple phenomenon, in which the NAC is positioned higher than the location initially marked by the surgeon [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Over the years, more than 50 surgical techniques have been developed and refined in an effort to address these complications and improve long-term aesthetic outcomes [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Various methods have also been proposed to determine the optimal intraoperative marking of the NAC in order to achieve stable postoperative results [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Accurate NAC positioning is particularly critical in patients with breast asymmetry, where even minor positional discrepancies may be more noticeable and clinically relevant [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCorrection of benign nipple malposition remains a challenging aspect of breast reduction surgery, and multiple strategies have been described in the literature to address this issue [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. In clinical practice, experienced plastic surgeons often intentionally mark the new nipple position slightly lower in patients with a long suprasternal notch\u0026ndash;to\u0026ndash;nipple distance and in cases of macromastia where a large volume of breast tissue is expected to be resected. This empirical adjustment is commonly applied in reduction mammoplasty for large breasts to compensate for postoperative tissue settling and positional changes over time.\u003c/p\u003e \u003cp\u003eBased on these clinical observations, the present study aimed to systematically evaluate the relationship between postoperative displacement of the nipple\u0026ndash;areola complex and breast resection weight. Although several previous studies have examined nipple position, breast measurements, and surgical outcomes using different methodologies, to the best of our knowledge, none have specifically investigated the association between the magnitude of NAC displacement following reduction mammoplasty and the weight of resected breast tissue in this manner. Compared with intraoperative marking, the SSN\u0026ndash;N distance demonstrated a mean reduction at the 3\u0026ndash;6-month postoperative follow-up, which was statistically significant (P\u0026thinsp;=\u0026thinsp;0.002). The average magnitude of this reduction in the present study was \u0026minus;\u0026thinsp;0.21 cm. In contrast, Altuntaş et al. reported a substantially greater mean reduction of \u0026minus;\u0026thinsp;1.75 cm in the SSN\u0026ndash;N distance in their analysis of 96 breasts, with a longer mean follow-up period of 19 months [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Differences in sample size, follow-up duration, and surgical technique may partly account for the discrepancy between these findings. Similarly, Ozan Bitik et al., who evaluated 75 breasts with a 2-year follow-up, observed that although the nipple position was approximately 1.2 cm higher at the early postoperative visit compared with intraoperative marking, no significant change in nipple position was detected during the 2-year follow-up period [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. In the study by Jamil Ahmad et al., which evaluated 49 patients with a 4-year follow-up, the nipple position was reported to be 1.3 cm higher on average five days after surgery and 1.0 cm higher at the 4-year follow-up compared with the intraoperative marking [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. These findings support the concept of elastic recoil of breast tissue following surgery, suggesting that the final nipple position tends to be, on average, higher than the initially planned intraoperative marking. Another aspect evaluated in the present study was the change in the N\u0026ndash;IMF distance between the measurement obtained one week postoperatively and that obtained at the 3\u0026ndash;6-month follow-up. Another finding of the present study was a significant increase in the N\u0026ndash;IMF distance between the measurement obtained one week postoperatively and that obtained at the 3\u0026ndash;6-month follow-up, with a mean increase of 0.49 cm. This observation is consistent with clinical findings commonly noted by plastic surgeons during long-term postoperative evaluations, in which inferior displacement and settling of breast tissue may occur over time.\u003c/p\u003e \u003cp\u003eSeveral technical modifications have been proposed to address this phenomenon and reduce postoperative lower-pole descent, including the vertical scar technique, which aims to improve breast projection and maintain long-term shape following reduction mammoplasty. Another finding of the present study was a significant increase in the N\u0026ndash;IMF distance between the measurement obtained one week postoperatively and that obtained at the 3\u0026ndash;6-month follow-up, with a mean increase of 0.49 cm. This observation is consistent with clinical findings commonly reported by plastic surgeons during long-term postoperative follow-up, in which inferior displacement and progressive settling of breast tissue may occur over time.\u003c/p\u003e \u003cp\u003eSeveral technical modifications have been proposed to address this phenomenon and reduce postoperative lower-pole descent, including the vertical scar technique, which aims to enhance breast projection and preserve long-term breast shape following reduction mammoplasty. Further support for these findings is provided by the observed relationship between changes in the N\u0026ndash;IMF distance and breast resection weight, which demonstrated a direct and statistically significant correlation (r\u0026thinsp;=\u0026thinsp;0.373). The absolute magnitude of this correlation was comparable to that observed for changes in the SSN\u0026ndash;N distance. In the present study, after stratifying resection weight into two categories (\u0026le;\u0026thinsp;500 g and \u0026gt;\u0026thinsp;500 g), it was found that 64.3% of breasts with a resection weight greater than 500 g exhibited postoperative superior displacement of the nipple relative to the preoperatively determined position, whereas no cases of superior nipple displacement were observed among breasts with a resection weight of 500 g or less (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In clinical practice, many experienced plastic surgeons intentionally position the new nipple slightly lower during preoperative marking in patients with large breasts. Based on the findings of the present study, it may be prudent to exercise additional caution in intraoperative nipple marking when the estimated breast resection weight exceeds 500 g. However, to establish a more precise predictive model or a standardized guideline for this purpose, further studies with larger sample sizes and longer follow-up periods are warranted. In cases of breast asymmetry, the results of the present study may also be of practical value. Differences in resected weight between the two breasts could be considered during preoperative planning to optimize nipple positioning and improve postoperative symmetry.\u003c/p\u003e\n\u003ch3\u003eLimitations\u003c/h3\u003e\n\u003cp\u003eThe study has limitations. The single-center design, small sample size, and involvement of a limited number of surgeons may limited the generalizability of the findings. In addition, the use of different surgical techniques and the relatively short follow-up period should be considered when interpreting the results. Future multicenter studies with larger sample sizes, longer follow-up durations, and technique-specific analyses are warranted to further validate these findings.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eBased on the findings of the present study, breasts with a greater resection weight appear to be more prone to postoperative superior displacement of the nipple relative to the surgeon\u0026rsquo;s initial intraoperative marking. Awareness of this association may assist plastic surgeons in refining intraoperative nipple positioning, particularly in cases in which the estimated resection weight exceeds 500 g (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Nevertheless, further studies are required before definitive recommendations can be established.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003e Conflict of interest\u003c/b\u003e:\u003c/h2\u003e \u003cp\u003enone.\u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003enone.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eE.R. and O.Y. contributed to conceptualization and study design.A.R. and M.Gh. were responsible for data collection and investigation.M. E. performed the statistical analysis and data interpretation.A.R. drafted the manuscript.All authors contributed to manuscript revision, read, and approved the final version.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eRan R et al (2025) Risk factors for complications after reduction mammaplasty: a systematic review and meta-analysis. Eur J Med Res 30(1):440\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang AY et al (2025) Nerve Blocks in Reduction Mammaplasty: A Systematic Review and Meta-Analysis of Pain Outcomes. J Surg Res 315:128\u0026ndash;138\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSharma S, Dhakad A (2025) Choosing the Right Pedicle for Reduction Mammoplasty: Balancing Vascularity and Aesthetics. Int J Aesthetic Plast Surg 1(2):131\u0026ndash;139\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGodwin Y et al (2014) A comparison of the patient and surgeon opinion on the long-term aesthetic outcome of reduction mammaplasty: have we improved over 15 years? J Plast Reconstr Aesthetic Surg 67(7):932\u0026ndash;938\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSachs D, Hattingh G, Szymanski KD (2025) Breast reduction. StatPearls [Internet]. StatPearls Publishing\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLewin R et al (2016) The aesthetically ideal position of the nipple\u0026ndash;areola complex on the breast. Aesthetic Plast Surg 40(5):724\u0026ndash;732\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWeale R, Javed MU (2025) Management of High-Riding Nipple-Areola Complex: A Systematic Review of Its Prevention and Management. Aesthetic Plastic Surgery, pp 1\u0026ndash;19\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSwanson E (2018) Photometric evaluation of long-term changes in breast shape after breast augmentation and vertical mammaplasty. Plast Reconstr Surgery\u0026ndash;Global Open 6(6):e1844\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchlittler F et al (2018) What is the incidence of implant malpositioning and revision surgery after orbital repair? J Oral Maxillofac Surg 76(1):146\u0026ndash;153\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAltuntaş ZK et al (2015) \u003cem\u003eLong-term changes in nipple-areolar complex position and inferior pole length in superomedial pedicle inverted \u0026lsquo;t\u0026rsquo;scar reduction mammaplasty.\u003c/em\u003e Aesthetic plastic surgery, 39(3): pp. 325\u0026ndash;330\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eISAPS (2019) International Survey on aesthetic/cosmetic procedures performed in 2018. International Society of Aesthetic Plastic Surgery\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePalve J et al (2022) Predictive risk factors of complications in reduction mammoplasty\u0026mdash;analysis of three different pedicles. Gland Surg 11(8):1309\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlnabi A et al (2023) Prospective observational study of Nipple\u0026ndash;Areola Complex Position post breast reduction. Wits J Clin Med 5(1):19\u0026ndash;24\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWatfa W et al (2022) Long-term evaluation of Nipple\u0026ndash;Areolar complex changes in inferior versus superomedial pedicle reduction mammoplasty: A comparative study. J Plast Reconstr Aesthetic Surg 75(3):1179\u0026ndash;1186\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMeshulam-Derazon S et al (2009) Large-volume breast reduction: long-term results. Scand J Plast Reconstr Surg Hand Surg 43(2):65\u0026ndash;70\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSpear SL, Albino FP, Al-Attar A (2013) Classification and management of the postoperative, high-riding nipple. Plast Reconstr Surg 131(6):1413\u0026ndash;1421\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNahabedian M (2018) Reduction mammaplasty with inverted-T techniques. Plast Surg E-Book 5:136\u0026ndash;159\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuly\u0026aacute;s G (2004) Marking the position of the nipple-areola complex for mastopexy and breast reduction surgery. Plast Reconstr Surg 113(7):2085\u0026ndash;2090\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhan HA, Bayat A (2008) A geometric method for nipple localization. Can J Plast Surg 16(1):45\u0026ndash;47\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ede Vita R et al (2019) Breast asymmetry, classification, and algorithm of treatment: our experience. Aesthetic Plast Surg 43(6):1439\u0026ndash;1450\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eColwell AS, May JW Jr, Slavin SA (2007) Lowering the postoperative high-riding nipple. Plast Reconstr Surg 120(3):596\u0026ndash;599\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBitik O, Uzun H (2016) Analysis of lower breast pole length and nipple\u0026ndash;areola complex position following superior pedicle, short horizontal scar breast reduction. Aesthetic Plast Surg 40(5):690\u0026ndash;698\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAhmad J, Lista F (2008) Vertical scar reduction mammaplasty: the fate of nipple-areola complex position and inferior pole length. Plast Reconstr Surg 121(4):1084\u0026ndash;1091\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"european-journal-of-plastic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ejps","sideBox":"Learn more about [European Journal of Plastic Surgery](https://link.springer.com/journal/238)","snPcode":"238","submissionUrl":"https://submission.nature.com/new-submission/238/3","title":"European Journal of Plastic Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Reduction mammoplasty, nipple-areola complex, nipple displacement, resected tissue volume","lastPublishedDoi":"10.21203/rs.3.rs-8797693/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8797693/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eReduction mammoplasty remains one of the most challenging surgery for many females in both physical and psychological aspects. The location of the nipple-areola complex (NAC) is a crucial factor in patient satisfaction and psychosocial function. To quantitatively assess the association between resected breast tissue volume and postoperative NAC displacement and to evaluate the predictive value of resection weight for clinically relevant nipple malposition.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eIn this cross-sectional study, thirty for women who were candidates for reduction mammoplasty surgery. Anatomical measurements, specifically the suprasternal notch to nipple (SSN-N) and nipple to inframammary fold (N-IMF) distances, were recorded preoperatively, intraoperatively (during surgical marking), and postoperatively at 1 week and 3\u0026ndash;6 months. The collected data were entered into the SPSS software. Group comparisons were conducted via t-tests or Mann-Whitney U tests. The correlation between various variables was evaluated using the Spearman or Pearson correlation test. Receiver operating characteristic (ROC) curve analysis was employed to appraise the prognostic value of resection weight for nipple displacement. Statistical significance was defined as p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eIn 64.3% of subjects whose resection weight was more than 500 grams, after surgery, the nipple was placed in a higher place than the previously determined place, while this percentage was equal to zero for those with resection weight less than 500 grams (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eHigher volumes of resected tissue in reduction mammoplasty are associated with increased nipple displacement and significant alterations in the N-IMF distance. These findings may assist surgeons in achieving more precise preoperative marking and improving the predictability of aesthetic results.\u003c/p\u003e","manuscriptTitle":"Nipple–Areola Complex Displacement After Reduction Mammoplasty: Association with the Volume of Resected Breast Tissue","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-27 13:22:56","doi":"10.21203/rs.3.rs-8797693/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-11T14:21:49+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-14T12:39:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"43236397215430715814620100845495921143","date":"2026-03-13T10:05:47+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-24T17:04:00+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-12T03:38:20+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-12T03:35:24+00:00","index":"","fulltext":""},{"type":"submitted","content":"European Journal of Plastic Surgery","date":"2026-02-05T13:07:20+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"european-journal-of-plastic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ejps","sideBox":"Learn more about [European Journal of Plastic Surgery](https://link.springer.com/journal/238)","snPcode":"238","submissionUrl":"https://submission.nature.com/new-submission/238/3","title":"European Journal of Plastic Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"85a52c9b-c096-47c5-8299-1ca74f794b57","owner":[],"postedDate":"February 27th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-17T09:09:49+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-27 13:22:56","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8797693","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8797693","identity":"rs-8797693","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}