Areola Reconstruction: Principles and Techniques

Abstract

At the end of breast reconstruction, the creation of a natural-appearing areola is very important for patient satisfaction with the surgical result. The challenging aspects of achieving this include matching the color and texture as well as the size, shape, position, and projection of a normal areola, particularly in unilateral cases. The most common techniques that have been used to create a naturalistic nipple–areola complex have included skin grafting, tattooing, or a combination of both. Surgeons are finding that tattooing, the intradermal electric deposition of pigments, can be used to closely approximate natural areola pigmentation. Using the appropriate technique is essential as it is known that tattoo pigment fades over time and appears somewhat different after intradermal applied. Indeed, physicians’ experience and color selection greatly affect the aesthetic outcome. Skin grafting has long been used in nipple–areola reconstruction, and skin donor sites such as retro- auricular, inner thigh, labia minora and contralateral areola have been employed. The choice of donor site depends on different factors, including the presence of a healthy contralateral areola and the skin tone of the patient. In some cases, tattooing may be used in conjunction with grafting. Regardless of areolar reconstructive technique, medical pigmentation is becoming a preferred method of producing a more realistic-appearing breast, although periodic touch-ups may be required for optimal results.

Studiu asupra reconstrucţiei de sân după mastectomie la pacientele diabetice

“…Prin proiecte naţionale de avengură precum Programul Naţional de Reconstrucţie Mamară un număr tot mai mare de paciente au acces la intervenţii chirurgicale reconstructive complexe. Tehnicile chirurgicale utilizate variază de la proceduri clasice de expandare tisulară urmată de augmentare prin introducerea protezelor siliconice, la intervenţii reconstructive complexe implicând asociarea protezelor siliconice cu lambouri miocutanate (1). Protocolul reconstructiv utilizat pentru tratamentul pacientelor după mastectomie (2,3) este adesea compus din multiple etape chirurgicale, debutând în majoritatea cazurilor cu expandarea tisulară prin introducerea unui expander tisular (4), urmată de refacerea defectului volumetric prin introducerea implantului siliconic sau transpoziţionarea unui lambou miocutanat, pentru ca în final să se realizeze reconstrucţia complexului areolă-mamelon, precum şi conturarea prin lipofilling.…”

Study on Reconstruction Techniques of the Nipple-Areola Complex

“…Therefore, terms such as nipple sparing, medical tattoo, unconventional breast tattoo, C-V flap technique are more and more common in the context of single-stage nipple-areolar reconstruction [5,6]. The desire to maximally reduce the time the patient is exposed to risks associated with the surgery including anesthesia, as well as to maintain the patients' degree of satisfaction at the highest level are elements that have contributed to the rapid development of the new reconstruction techniques dedicated to the nipple-areola complex [7,8].…”