Mammillary fistula revisited: Implications for immediate breast reconstruction.

We present two patients with inverted nipples who underwent bilateral nipple-sparing mastectomies (NSM) with immediate placement of tissue expanders with acellular dermal matrix (ADM). Both were complicated by postoperative infection and developed mammillary fistulae from the nipple into the breast capsule, and eroding through the ADM. For the first time, we report inverted nipples as a risk for the iatrogenic formation of mammillary fistulae and their infectious implications after NSM.