Immediate Nipple-Areolar Complex Reconstruction for Patients Undergoing Implant-Based Reconstruction or Therapeutic Mammoplasty

Abstract

Background:We report a technique of immediate nipple-areolar complex (NAC) reconstruction for patients undergoing skin-sparing mastectomy and implant-based breast reconstruction or therapeutic mammoplasty with central excision.Methods:Immediate nipple reconstruction is performed using a modified C-V flap planned along the edge of the incision. The areola is reconstructed using a full-thickness skin graft taken from skin usually discarded during the procedure. Immediate NAC reconstruction using this technique was performed on 32 breasts in 21 patients. This included 19 risk-reducing mastectomies, 9 therapeutic mastectomies, and 2 major revisions to existing implant reconstruction. Reconstruction was direct to implant in 29 breasts and by expander in 1 breast. The device was placed in a pre- or post-pectoral plane utilizing dermal sling and/or acellular dermal matrix as determined on a case-by-case basis. Immediate NAC reconstruction was also performed on 2 patients undergoing therapeutic mammoplasty with central excision.Results:Mean follow-up is 12 months (5–27 months), and cosmetic results have been good. There have been no significant complications, and no revisional surgery has been required.Conclusion:The application of simple techniques for NAC reconstruction in the primary procedure allows reconstruction of the whole breast in a single stage. There is an immediate focal point to the reconstruction to improve cosmesis, patient satisfaction, and psychosocial function without delay.

Analysis of Secondary Surgeries after Immediate Breast Reconstruction for Cancer Compared with Risk Reduction

“…It is worth noting that nipple reconstruction was one of the most commonly performed secondary surgical procedure. Therefore, one might consider surgical techniques such as immediate NAC reconstruction 20 to reduce secondary surgery rates as well as delay in the completion of reconstructive journey.…”

Reconstruction of the Areola-Nipple Complex after Mastectomy

“…In tattooing in unilateral cases, slightly more pigmented colors should be chosen than the contralateral areola. Lanza and Arias found that 9.5% of the areolas needed retouching to pigment fading and it is likely that he will need to retouch the tattoo after several months or years to achieve an aesthetically symmetric color match [7][8][9]14].…”

“…The first ones based on the creation of prominence from neighborhood flaps with random flow, the main problem being the loss of projection. The viability of these flaps can be affected by radiotherapy and in breasts with multiples scars derived from successive surgeries that compromise the vascular flow of the flaps [4,6,7].…”

Update in Direct-to-Implant Breast Reconstruction

“…In addition, free nipple grafting can be offered in carefully selected patients with good outcome, but is subject to high risk of nipple loss. 21,22 Preoperative Planning…”