Nipple-Areolar Complex Reconstruction: A Compilation of Techniques to Achieve a Natural Result

Background

The nipple-areolar complex (NAC) is a defining feature of a woman’s breast anatomy that is often lost following mastectomy and breast reconstruction. Numerous methods of nipple-areolar reconstruction have been described, yet patients still report high levels of dissatisfaction with the final results. This may be due to the unnatural appearance of the reconstructed NAC. We present a series of techniques utilized to achieve optimal nipple-areolar reconstruction aesthetics.

Methods

A retrospective review of a single surgeon’s practice was performed from January 2008 until December 2014. Patient follow-up ranged from 1 to 8 years. Pre-mastectomy color evaluations of the native nipple-areolar complex were performed. All patients that underwent reconstruction had simultaneous nipple-areolar tattooing utilizing a blending method. The specific NAC local flap was determined based on the patient’s individual scar pattern.

Results

There were a total of 342 patients included; 140 reconstructions were unilateral (41%) and 202 reconstructions were bilateral (59%). Sixty-eight patients (20%) had fading of their tattoo, of which 34 patients (10%) underwent nipple color retouching. The most common area that required additional tattooing was the mastectomy scar. Thirty patients (9%) underwent secondary nipple reconstruction due to loss of nipple projection. One hundred and two patients (30%) developed superficial epidermolysis of the reconstructed NAC which was managed with local wound care alone. There were no cases of full thickness necrosis of the NAC that required debridement. Overall, 290 patients (85%) were satisfied with their nipple-areolar reconstruction.

Conclusion

This is the largest series of patients undergoing NAC reconstruction that we know of. We currently use a variety of techniques that may lead to a natural outcome and a greater satisfaction rate from NAC reconstruction. Our methods include a pre-mastectomy color match, tattooing with a blending technique, and choosing a patient specific local flap for the NAC. In particular, the pre-mastectomy color matching for the NAC during the initial consultation for all mastectomy patients has proven to be highly beneficial for reconstruction at a later stage. These are practical modifications that can be easily implemented to augment nipple-areolar reconstructions.