Nipple Reconstruction Techniques: Which is the Best Choice?

Abstract

Nipple-Areolar Complex (NAC) reconstruction represents the final, concluding journey of breast reconstruction by being able to give to reconstructed breasts the shape of a natural breast mound. Nevertheless an enormous amount of nipple reconstruction techniques are described in literature, given the fact that most reconstructive options fail to give satisfactory outcomes in relation to the long-term nipple projection. In this review, the authors will browse most common nipple reconstruction techniques, taking into account: Indication, outcome, and side effect. Composite nipple grafts, traditional flaps, flaps with autologous graft augmentation, flaps with allograft augmentation, and flaps with alloplastic augmentation are the main strategies employed nowadays. Composite nipple grafts give the best guarantee of color-texture match with the contralateral side and show satisfactory nipple projection even at long-term follow-up. Skate, star, C-V, and arrow flap are by far the most commonly employed and the most reliable local flaps, however loss of projection of up to 70 percent are reported in literature. Alloplastic grafts were associated with the lowest rates of projection loss followed by autologous and allogenic ones. Nevertheless allogenic grafts are also associated with the highest complication rate, while autologous and allogenic ones have similar rates. Infection, seroma, and fat necrosis are the more commonly reported complications of autologous grafting along with donor site morbidity, while allogenic and alloplastic augmentation grafts may also experience the risk of overcorrection and graft exposure. Given the numerous techniques described in literature it is clear that the ideal nipple reconstruction hasn't been found yet. Whereas it should be chosen on case to case basis depending on type of mastectomy, radiotherapy, type of reconstruction, skin thickness, tissue condition, and patients' expectations to ensure the best cosmetic outcome.

Guiding Nipple-Areola Complex Reconstruction: Literature Review and Proposal of a New Decision-Making Algorithm

“…Synthetic materials are foreign bodies which serve as internal implants and include silicone gel or rods [ 39 ], hyaluronic acid, calcium hydroxylapatite (Radiesse TM )[ 40 ], artificial bone substance (Ceratite TM ) [ 41 , 42 ] and polytetrafluoroethylene [ 43 ]. Acellular dermal matrices (AlloDerm TM , GCDerm, SureDerm) and the Biologic Collagen Cylinder [ 10 ] are classified as allogenic materials [ 11 , 44 ]. They use decellularized nipple scaffolds that support recellularization with the host’s own cells [ 45 , 46 ].…”

“…When the unaffected nipple has a projection > 1 cm, consider using nipple sharing, otherwise use local flaps. The most commonly used flaps include the skate, star, C-V and arrow flaps [ 44 ]. Conversely, when reconstruction is bilateral, previously mentioned anatomical landmarks should be applied to appropriately locate the NAC.…”