A Modified Technique for Nipple-Areola Complex Reconstruction

Abstract

Nipple-areola complex (NAC) reconstruction is the final step of the breast reconstructive ladder, in which a surgically created mound, transformed into an aesthetically pleasing breast, restores the body image of breast cancer patients, achieving a psychological acceptance of the new body. Correct location and an adequate size of the nipple-areola complex are mandatory for a beautiful breast. A frequent drawback of the methods currently used for nipple reconstruction is the loss of nipple projection in the longer postoperative term, and several techniques have been developed over the past years, in an effort to overcome the ongoing challenge of maintaining sustained nipple projection. Moreover, timing of reconstruction and postsurgical radiotherapy play an important role in the final outcome. In fact, the difficulty in determining the ideal position of the nipple-areola complex, when the effects of postoperative settling of the breast mound are unpredictable, is increased by the presence of an irradiated field in both a delayed or immediate reconstruction.

Anyway, in both an immediate and delayed reconstruction, even if a radiation treatment is not planned, a loss of nipple projection has to be considered, as the main effect of a physiological tissue modification, attributable to a fat component reabsorption. Compared to other nipple reconstruction procedures, the fleur-de-lis flap technique is a good option to overcome this effect with satisfactory results.