A novel technique for immediate nipple reconstruction with a rectangular flap in implant-based breast reconstruction

Abstract

IntroductionA nipple reconstruction complements breast mound restoring in postmastectomy breast cancer patients. It positively affects patients' welfare, both in psycho-social and sexual aspects. An immediate nipple reconstruction is an alternative approach to delayed surgery. We describe an original technique for an immediate nipple reconstruction by the use of a modified rectangular flap.Material and methodsOne hundred seventeen nipple reconstructions in 112 breast cancer patients were performed. This technique was used during skin-sparing mastectomy, including 104 implants (88.9%) and 13 tissue-expander (11.1%) breast reconstructions. Synthetic meshes covered with titanium supported lower breast poles in 72 implantations (61.5%); in remaining cases, (38.5%) muscles covered the entire implant. Preoperative chemotherapy was applied in 18.75% of the patients; adjuvant chemo- and hormonal therapy obtained 29.5% and 74.1% of the patients, respectively. Twenty-four patients (21.4%) were irradiated postoperatively.ResultsIn 5 out of 117 surgeries (4.3%), necrosis of the rectangular flap was observed. Twelve months since surgery, two-loss of projection of reconstructed nipple was reported (1.7%). In the twelfth month of observation, of the subgroup of 102 patients with permanent nipple presentation, 93.1% gave a positive opinion regarding the procedure.ConclusionsThe given immediate nipple reconstruction technique performed during a skin-sparing mastectomy and implant/expander-based breast reconstruction was an effective and safe adjunct curative breast surgery.