Donor Site Morbidity and Patient Satisfaction Using a Composite Nipple Graft for Unilateral Nipple Reconstruction in the Radiated and Non-Radiated Breast

Background: The number of techniques available for nipple reconstruction underscores the notion that achieving an optimal result remains a challenge, especially when performing unilateral breast reconstruction. A study was performed to evaluate donor site morbidity and patient satisfaction using a composite nipple graft for nipple reconstruction following mastectomy in radiated and non-radiated patients. Methods: A retrospective chart review of all patients who underwent composite nipple reconstruction between October 1993 and February 2009 was performed. Medical records were reviewed for outcomes and complications. Each patient was asked to complete a survey to rate the color and projection of both nipples, donor site sensation, contractility, role in sexuality, and whether she would have the procedure if she could go back in time. Results: 31 of 55 (56.36%) patients responded to the survey. Average time to breast mound completion was six months. Average time to completion of nipple reconstruction was 3.6 months after breast mound completion. All but two nipple reconstructions were successful. 18 patients received radiation to the breast. When asked about the reconstructed nipple, 90% of responding patients indicated they were somewhat or very satisfied with the nipple's appearance. 87% of responding patients indicated they were somewhat or very satisfied with the naturalness of the nipple. 84% of responding patients indicated they were somewhat or very satisfied with the height of the nipple. 63% of responding patients indicated sensation of the donor nipple decreased only somewhat or not at all. 55% of responding patients indicated the donor nipple had normal or near normal contraction. 50% of responding patients indicated that the donor nipple had almost adequate or adequate projection. 63% of responding patients indicated the role of the nipple in her femininity/sexuality was only slightly decreased or unchanged after surgery. 79% of responding patients indicated they would probably or definitely undergo this procedure again. Conclusions: Composite nipple reconstruction is a useful technique which should be considered in unilateral nipple reconstruction and should be especially considered in patients whose breast has been radiated and/or where flap nipple reconstruction is contraindicated. While not possible to use in all patients, no other technique offers a nipple reconstruction which can so closely match the contralateral side in color, texture, and overall appearance.