Nipple reconstruction and mastectomy scars

Simultaneous nipple reconstruction in autologous breast reconstruction

BACKGROUND

Reconstruction of the nipple-areola complex is the final step in surgical restoration of the breast. Nipple-areola reconstruction was previously done after an interval of several months using variable techniques, often resulting in low projection and flattened breast mound over time. We present algorithm of simultaneous nipple reconstruction (SNR) that leaves adequate residual projection and naturally shaped breast mound.

METHODS

Forty patients underwent a skin-sparing mastectomy and nipple excision between October 2016 and December 2020. In the control group, 21 patients underwent delayed nipple reconstruction for 6 months after breast reconstruction. The experimental group of 19 patients underwent nipple and breast reconstruction simultaneously. We collected relevant information and photographs of nipple profiles of both groups in the preoperative, postoperative 6-month, and postoperative 1-year time periods. We also examined the ratio between the reconstructed and contralateral nipples.

RESULTS

Scores regarding patient satisfaction questionnaire averaged higher in experimental groups to every category. The control group's scores gradually declined over time and the experimental group showed lesser decline. At the 1-year postoperative follow-up, the mean projection of the immediately reconstructed nipple was approximately the same as the contralateral nipple at 91%, whereas the delayed reconstructed nipple resulted in a 77% ratio.

CONCLUSIONS

Nipple reconstruction should no longer be considered as a secondary complement to immediate breast reconstruction. The nipple appears to be essential component of breast reconstruction for patient. SNR with immediate breast reconstruction is a simple and reliable technique, giving stable aesthetic results over time.

Immediate Nipple Reconstruction on a Free TRAM Flap Breast Reconstruction

BACKGROUND

Reconstruction of the nipple-areola complex is usually deferred until breast mound reconstruction is complete. The authors review their experience with a technique that allows for shaping of a free transverse rectus abdominis myocutaneous (TRAM) flap and immediate nipple reconstruction and compare this technique with delayed nipple reconstruction.

METHODS

A retrospective chart review demonstrated 21 patients who underwent immediate nipple reconstruction, 10 of whom had complete photographs and records for review. Ninety patients underwent delayed nipple reconstruction. Twenty of these patients were chosen for comparison, 15 of whom had complete photographs and records. Age, body mass index, comorbidities, procedures required, complications, and time to completion were reviewed. A multiobserver, multicharacteristic, standardized photographic review of cosmetic outcomes was conducted.

RESULTS

Time from mastectomy to completion of reconstruction, not including areolar tattooing, was 1 day (median) versus 125 days (median) in the immediate and delayed groups, respectively (p = 0.003). The number of procedures required to complete reconstruction before areolar tattooing was one (median) in the immediate group and two (median) in the delayed group (p < 0.001). Complication rates were similar in both groups. Subjective review demonstrated no difference in the aesthetic outcome of the breast mound or nipple-areola complex reconstruction.

CONCLUSIONS

Patients having immediate nipple reconstruction in the setting of a free TRAM breast reconstruction completed their reconstruction earlier, required fewer procedures, and had aesthetic results comparable to patients having traditional delayed nipple reconstruction. Complications and revision rates were comparable.