Abstract
Background
Reconstruction of the nipple–areola complex (NAC) is the last stage of breast reconstruction and represents the search for symmetry in regard to the contralateral breast. The objective of this study was to present an areola reconstruction technique with local skin graft to improve the texture and aspect of the reconstructed areola, searching for a natural look.
Methods
This technique was performed on 122 patients who in the period from January 2000 to December 2005 were submitted to nipple and areola reconstruction. Once the position of the new nipple was determined, markings were made for the reconstruction of the areola. Then the external limit of the new areola was incised and the skin was centripetally deepidermized up to 85% of its diameter. After this procedure the detached skin was repositioned in its bed as a graft and sutured with 4.0 mononylon thread. Incisions with an 11-blade scalpel were then made in V and C forms associated with the detachment of this skin of the receptor area along the local graft so that at the end of the healing process they would determine alterations in the areolar texture mimicking the texture of a normal areola. All patients underwent tattooing 3 months after reconstruction of the NAC taking into account the different shades of the contralateral areola and nipple colors.
Results
The use of a local skin graft associated with C and V incisions allowed alteration in the texture of the reconstructed areola. The use of different ink shades for tattooing helped to give a tridimensional aspect to this areola. These factors determined a good aesthetic result in these patients.
Conclusion
This areola reconstruction using a local skin graft allows change in the areola texture and a tridimensional aspect similar to that of a normal areola without the inconvenience of grafting from a distance.
Similar content being viewed by others
References
Brent B, Bostwick J (1977) Nipple–areolar reconstruction with auricular tissues. Plast Reconst Surg 60:353–361
Bhatty MA, Berry RB (1997) Nipple–areola reconstruction by tattooing and nipple sharing. Br J Plast Surg 50(5):331–334
Chang WH (1984) Nipple reconstruction with a T-flap. Plast Reconstr Surg 73:140–143
Chen SG, Chiu TF, Su WF et al (2005) Nipple-areola complex reconstruction using badge flap and intradermal tattooing. Br J Surg 92:435–437
Cronin ED, Humphreys DH, Ruiz-Razura A (1988) Nipple reconstruction: the S flap. Plast Reconstr Surg 81:783–787
Eskenazi L (1993) A one-stage nipple reconstruction with the “modified star” flap and immediate tattoo: a review of 100 cases. Plast Reconstr Surg 92:671–680
Eng JS (1996) Bell flap nipple reconstruction: a new wrinkle. Ann Plast Surg 6:485–488
Gamboa-Bobadilla GM (2005) Nipple reconstruction: the top hat technique. Ann Plast Surg 54:243–246
Hartrampf CR, Culbertson JH (1984) A dermal-fat flap for nipple reconstruction. Plast Reconstr Surg 73:982–986
Hallock GG, Altobelli JA (1993) Cylindrical nipple reconstruction using an H flap. Ann Plast Surg 30:23–26
Hugo NE, Sultan MR, Hardy SP (1993) Nipple-areola reconstruction with intradermal tattoo and double-opposing pennant flaps. Ann Plast Surg 30:510–513
Jabor MA, Shayani P, Collins DR, Karas T, Cohen BE (2002) Nipple–areolar reconstruction: satisfaction and clinical determinants. Plast Reconstr Surg 110:457
Kroll SS, Hamilton S (1989) Nipple reconstruction with double-opposing-tab flap. Plast Reconstr Surg 84:520–525
Kroll SS, Reece GP, Miller MJ et al (1997) Comparison of nipple projection with the modified double-opposing tab and star flaps. Plast Reconstr Surg 99:1602–1605
Kroll SS (1999) Integrated breast mound reduction and nipple reconstruction with the wraparound flap. Plast Reconstr Surg 104:687–693
Kroll SS (1999) Nipple reconstruction with the double-opposing tab flap. Plast Reconstr Surg 104:511–514
Little JW III (1983) One-stage reconstruction of a projecting nipple: the quadripod flap. Plast Reconstr Surg 71:126–133
Losken A, Mackay GJ, Bostwick J III (2001) Nipple reconstruction using the C–V flap technique: a long-term evaluation. Plast Reconstr Surg 108:361–369
Lossing C, Brongo S, Holmström H (1998) Nipple reconstruction with a modified S-flap technique. Scand J Plast Reconstr Surg Hand Surg 32:275–279
Puckett CL, Concannon MJ, Croll GH et al (1992) Nipple reconstruction using the “inchworm” flap. Aesthetic Plast Surg 16:117–122
Ramakrishnan VV, Mohan D, Villafane O et al (1997) Twin flap technique for nipple reconstruction. Ann Plast Surg 39:241–244
Shestak KC, Gabriel A, Landecker A, Peters S, Shestak A, Kim J (2002) Assessment of long-term nipple projection: a comparison of three techniques. Plast Reconstr Surg 110:780–786
Tanabe HY, Tai Y, Kiyokawa K et al (1997) Nipple–areola reconstruction with a dermal-fat flap and rolled auricular cartilage. Plast Reconstr Surg 100:431–43824
Wellisch DK, Schain WS, Noone RB, Little JW III (1987) The psychological contribution of nipple addition in breast reconstruction. Plast Reconstr Surg 80:699–704
Andrade WN, Baxter N, Semple JL (2001) Clinical determinants of patient satisfaction with breast reconstruction. Plast Reconstr Surg 107:46–54
Nahabedian, MY, Tsangaris TN (2006) Breast reconstruction following subcutaneous mastectomy for cancer: a critical appraisal of the nipple-areola complex. Plast Reconstr Surg 117:1083–1090
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Costa, M.P., Ferreira, M.C. Aesthetic Quality of the Nipple–Areola Complex in Breast Reconstruction with a New Local Graft Technique. Aesth Plast Surg 33, 774–779 (2009). https://doi.org/10.1007/s00266-009-9387-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00266-009-9387-z