A two nipple technique: Nipple areola reconstruction for the hypoplastic nipple areola complex

Abstract

We describe a novel approach to reconstruction of the superiorly placed hypoplastic nipple areola complex (NAC) with the aim of retaining sensation of the nipple and avoiding scars on the upper pole of the breast. We used this novel approach for a 38 year old lady with right sided Poland sequence. She had a previously (ruptured) subcutaneous right breast implant and subsequent DIEP breast reconstruction. The hypoplastic NAC remained superiorly placed. Nipple reconstruction was then performed, along with superior pole breast lipofilling and a left sided symmetrising mastopexy. A modified CV flap was used to reconstruct the right nipple using stored cartilage (from previous DIEP surgery). The new nipple was sited close enough to the existing hypoplastic NAC to allow it to be incorporated into the new areola, which was reconstructed with an areola graft from left breast. The theory is that the hypoplastic nipple would be disguised in the reconstructed areola with the appearance more like a montgomery tubercle than a NAC. The patient retains neurovascularity and hence sensation within this area, and there is no need for any scars above the NAC. Although, complicated by some flap and graft necrosis and need for post-operative tattooing to improve cosmesis, we would advocate the use of our technique with some minor adjustments.