Nipple Areolar Complex (NAC)
The nipple areolar complex (NAC) is the one recognizable landmark on the breasts. The position of the NAC relative to the breast mounds and the surrounding landmarks such as the collar bone, the sternum, the lower rib cage, etc. is critical. Incising around the NAC and moving it on a vascularized base is a common maneuver in breast operations. However, procedures are designed to incorporate these incisions to create planned access to the breast tissues and can be closed to minimize the appearance of the scars. Moving the NAC on a pedicle would deform the current breast mound and create a donor wound which would be impossible to hide.
Returning an NAC to a near normal position may not be an easy task. Options would include removing it entirely and reapplying the areola as a full thickness skin graft. That will leave the shape of the breast mound relatively undisturbed but will leave a large round open donor site in a visible area where the NAC is currently located. The grafted NAC would be insensate and flat, and without projection like a normal nipple. The donor site could be also be skin grafted with skin borrowed from elsewhere, which would look like a permanent patch. The wound could be allowed to heal secondarily, which would result in a large unsightly scar. It could be patched, then serially excised to minimize the visible exposed area of scarring. These are staged operations, but are very bad options that would only be considered salvage to make a very bad outcome somewhat better but really is just trading unacceptable plastic surgery results for other (slightly less) unacceptable plastic surgery results along with attendant risks including infection, loss of NAC due to necrosis, loss of sensitivity, and other surgical risks. Unfortunately, there are no other better options.
Nipple areolar complex medical expert witness specialties include breast surgery, plastic surgery, and surgical oncology.