27 - Reconstruction of the nipple areolar complex

Abstract

Reconstruction of the nipple areolar complex (NAC), for many women, is perceived as the final battle in their war against breast cancer, completing the restoration of form that most closely resembles a native breast. While those patients content with a normal appearance in clothing following breast reconstruction may choose not to pursue NAC reconstruction, those who do have the option of prostheses, local flaps, skin grafts, tattooing, or some combination of the above. Tattooing techniques have evolved to produce a remarkably natural appearance of the NAC with an essentially non-invasive office-based procedure, albeit with the shortcoming of lack of nipple projection. To create a projected nipple, grafts of the contralateral nipple, auricular tissue, use of prosthetics, and local flaps can all be performed. Local flaps usually require initial over-projection due to loss of projection over time, do not recreate natural intermittent erectility, and may be less desirable in reconstructed breasts with thin tissue overlying a prosthetic implant. Though immediate NAC reconstruction, at the same time as the primary breast reconstruction procedure, has been described, it is more common to delay NAC reconstruction until the final shape of the reconstructed breast has stabilized to ensure correct and symmetrical positioning. Preservation of the NAC with NAC-sparing mastectomy or tissue banking with delayed grafting, if oncologically sound, usually and more reliably achieves superior aesthetic results. Patients must be counseled that all current techniques of NAC preservation and reconstruction fail to confer erogenous or nursing function.