[The reconstruction of the nipple-areolar]

[Nipple-areola complex malformations]

THE NIPPLE-AREOLA COMPLEX, ALSO KNOWN AS THE NIPPLE-AREOLA PLATE, IS AN ESSENTIAL VISUAL FEATURE OF THE BREAST.THIS COMPLEX CAN BE AFFECTED BY VARIOUS MALFORMATIONS, BOTH CONGENITAL AND ACQUIRED. ALTHOUGH THESE ANOMALIES OFTEN HAVE A MODERATE IMPACT ON THE FUNCTIONALITY OF THIS COMPLEX, THE RESULTING PSYCHOLOGICAL CONSEQUENCES CAN BE SIGNIFICANT. THEIR TREATMENT IS MOST OFTEN SURGICAL AND MANY TECHNIQUES HAVE BEEN DESCRIBED OVER THE YEARS TO RECONSTRUCT AREOLA AND NIPPLE. REGARDLESS OF THE TECHNIQUE USED, THIS ONE AS TO BE SIMPLE, QUICK, IMITATE AS CLOSELY AS POSSIBLE A NATIVE AREOLA-NIPPLE COMPLEX AND BE RELATIVELY DURABLE, AVOIDING NUMEROUS SURGICAL PROCEDURES.: .

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

BACKGROUND

Nipple-areola complex reconstruction (NAR) most commonly represents the finishing touch to breast reconstruction (BR). Nipple presence is particularly relevant to the patient's psyche, beyond any shadow of doubt. Many reconstructive options have been described in time. Surgery is easy, but final result is often disappointing on the long run.

METHODS

The goal of this manuscript is to analyze and classify knowledge concerning NAR techniques and the factors that influence success, and then to elaborate a practical evidence-based algorithm. Out of the 3136 available articles as of August 8th, 2020, we selected 172 manuscripts that met inclusion criteria, which we subdivided into 5 main topics of discussion, being the various NAR techniques; patient factors (including patient selection, timing and ideal position); dressings; potential complications and finally, outcomes/patient satisfaction.

RESULTS

We found 92 articles describing NAR techniques, 41 addressing patient factors (out of which 17 discussed patient selection, 14 described ideal NAC location, 10 described appropriate timing), 10 comparing dressings, 7 studying NAR complications, and 22 addressing outcomes and patient satisfaction. We elaborated a comprehensive decision-making algorithm to help narrow down the choice among NAR techniques, and choose the correct strategy according to the various scenarios, and particularly the BR technique and skin envelope.

CONCLUSIONS

No single NAR technique provides definitive results, which is why we believe there is no "end-all be-all solution". NAR must be approached as a case-by-case situation. Furthermore, despite NAR being such a widely discussed topic in scientific literature, we still found a lack of clinical trials to allow for more thorough recommendations to be elaborated.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

[Secondary surgical and medical treatment of scars]

The authors, through their experience, take stock of current secondary management of scars whether they are pathological (hypertrophic, cheloid) or dystrophic (enlarged, hypo- or hyper-pigmented, adherent) by presenting surgical or medical solutions.