Simultaneous Nipple Reconstruction during Immediate Autologous Breast Reconstruction in Skin-sparing Mastectomy

Abstract

Background: Reconstruction of nipple-areolar complex is the final stage of breast reconstruction in mastectomy patients. Especially in patients who underwent skin sparing mastectomy (SSM), this final step is essential. Nipple reconstruction is usually done with the interval of several months after breast reconstruction, because simultaneous reconstruction is thought to be risky in the flap circulation. However, we introduce our experiences of one-stage procedures with immediate nipple-areolar complex reconstruction during autologous breast reconstruction in SSM patients.

Patients and methods From 2008 to 2015, total 51 SSM patients experienced one-stage breast and nipple reconstruction. All cases were reconstructed with transverse rectus abdominis myocutaneous (TRAM) or latissimus dorsi (LD) flap for breast mound. Simultaneous nipple reconstruction was mostly performed with C-H flap. The evaluation of the nipple-areolar complex was done at preoperative, immediate postoperative and postoperative one year time. The evaluation included projection and width of nipple, and size of areola. Postoperative complications about reconstructed nipple-areolar complex and breast mound were also evaluated.

Results The mean projection of reconstructed nipple decreased about 47% in postoperative one year, whereas reconstructed nipple width and areolar diameter did not show significant change. There was no major complication for breast mound flap and nipple-areolar complex. But in 15 cases there were minor complications on nipple-areolar complex, and all complications like unsatisfactory projection of nipple or size differences of areola could be fixed with simple procedures. And in 3 cases, they had mastectomy skin necrosis on breast mound and minor revision operations were done for complete healing.

Conclusion With careful surgical approach, simultaneous breast and nipple reconstruction in SSM patients is safe and brings satisfactory results.