Purpose: To evaluate the feasibility and outcome of immediate nipple reconstruction on a free TRAM flap

Materials and Methods: A retrospective review of patients having free TRAM flap breast reconstruction identified ten patients that underwent simultaneous nipple reconstruction. Comparison was made to fifteen patients with delayed nipple reconstruction. Multiple variables including age, BMI, co-morbidities, procedures required, complications, and length of reconstruction were compared. A multi-observer, multi-characteristic comparison of cosmetic outcome was conducted based on standardized photographs.

Results: Patients undergoing immediate nipple reconstruction had a significantly lower BMI (23.8 kg/M2 vs. 28 kg/M2, p = 0.02). They also required fewer procedures to get to the point of areolar tattooing (1.4 operations vs. 2.2 operations, p=0.001), and to complete the entire reconstruction (2.5 operations vs. 3.7 operations, p = 0.008).

Comparison of standardized postoperative photographs revealed no statistical difference in aesthetic outcome of the breast mound or nipple-areola complex between immediate and delayed nipple reconstruction.

Conclusion and Summary: Immediate nipple reconstruction on a free TRAM flap breast reconstruction using a fish tail flap is reliable. In a subset of thinner patients, it provides a symmetrical and aesthetically pleasing breast mound and nipple-areola complex reconstruction in fewer procedures.