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A Modified Technique for Nipple-Areola Complex Reconstruction

  • Pier Camillo Parodi
  • Daria Almesberger
Chapter

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.

References

  1. 1.
    Spear SL, West JE. NAC reconstruction. In: Spear SL, Willey SC, Robb GL, Hammond DC, Nahabedian NY, editors. Surgery of the breast: principles and art. Philadelphia: Lippincott, Williams & Wilkins; 2011.Google Scholar
  2. 2.
    Blondeel PN, Hijjawi J, Depypere H, Roche N, Van Landuyt K. Shaping the breast in aesthetic and reconstructive breast surgery: an easy three-step principle. Plast Reconstr Surg. 2009;123(2):455–62.CrossRefPubMedGoogle Scholar
  3. 3.
    Shestak KC, Gabriel A, Landecker A. Assessment of long-term nipple projection: a comparison of three techniques. Plast Reconstr Surg. 2002;110(3):780–6.CrossRefPubMedGoogle Scholar
  4. 4.
    Jabor MA, Shayani P, Collis DR Jr, Karas T, Cohen BE. Nipple-areola reconstruction: satisfaction and clinical determinants. Plast Reconstr Surg. 2002;110(2):457–63.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Craig ES, Walker ME, Salomon J, Fusi S. Immediate nipple reconstruction utilizing the DIEP flap in areola-sparing mastectomy. Microsurgery. 2013;33(2):125–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Momeni A, Ghaly M, Gupta D, Karanas YL, Kahn DM, Gurtner GC, Lee GK. Nipple reconstruction: risk factors and complications after 189 procedures. Eur J Plast Surg. 2013;36(10):633–8.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Spear SL, Onyewu C. Staged breast reconstruction with saline-filled implants in the irradiated breast: recent trends and therapeutic implications. Plast Reconstr Surg. 2000;105:930–42.CrossRefPubMedGoogle Scholar
  8. 8.
    Lin KY, Blechman AB, Brenin DR. Implant-based, two-stage breast reconstruction in the setting of radiation injury: an outcome study. Plast Reconstr Surg. 2012;129:817–23.CrossRefPubMedGoogle Scholar
  9. 9.
    Delanian S, Lefaix JL. The radiation-induced fibroatrophic process: therapeutic perspective via the antioxidant pathway. Radiother Oncol. 2004;73:119–31.CrossRefPubMedGoogle Scholar
  10. 10.
    Losken A, Mackay GJ, Bostwick J. Nipple reconstruction using the C-V flap technique: a long-term evaluation. Plast Reconstr Surg. 2001;108(2):361–9.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Lossing C, Brongo S, Holmström H. Nipple reconstruction with a modified S-flap technique. Scand J Plast Reconstr Surg Hand Surg. 1998;32(3):275–9.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Few JW, Marcus JR, Casas LA, Aitken ME, Redding J. Long-term predictable nipple projection following reconstruction. Plast Reconstr Surg. 1999;104:1321–4.CrossRefPubMedGoogle Scholar
  13. 13.
    Gamboa-Bobadilla GM. Nipple reconstruction: the top hat technique. Ann Plast Surg. 2005;54:243–6.PubMedPubMedCentralGoogle Scholar
  14. 14.
    Nahabedian MY. Secondary nipple reconstruction using local flaps and AlloDerm. Plast Reconstr Surg. 2005;115:2056–61.CrossRefPubMedGoogle Scholar
  15. 15.
    Peled IJ. Purse-string suture for nipple projection. Plast Reconstr Surg. 1999;103:1480–2.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Vecchione TR. Reconstruction and/or salvage of nipple projection. Plast Reconstr Surg. 1986;78:679–83.CrossRefPubMedGoogle Scholar
  17. 17.
    Yanaga H. Nipple–areola reconstruction with a dermal-fat flap: technical improvement from rolled auricular cartilage to artificial bone. Plast Reconstr Surg. 2003;112(7):1863–9.CrossRefPubMedGoogle Scholar
  18. 18.
    Mohamed SA, Parodi PC. A modified technique for nipple-areola complex reconstruction. Indian J Plast Surg. 2011;44(1):76–80.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Germanò D, De Biasio F, Piedimonte A, Parodi PC. Nipple reconstruction using the fleur-de-lis flap technique. Aesthet Plast Surg. 2006;30(4):399–402.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Department of Plastic Surgery-Academic HospitalUniversity of UdineUdineItaly
  2. 2.Department of Medical, Experimental and Clinical Sciences—Plastic and Aesthetic SurgeryUniversity of UdineUdineItaly

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