Evaluating the Efficacy and Patient Satisfaction of Nipple-Areola Complex Reconstruction Using the Nipple-Sharing Technique and Perineal Skin Graft After Breast Reconstruction.

Patient satisfaction following nipple-areolar complex reconstruction and tattooing

Following mastectomy, nipple-areola complex (NAC) reconstruction is seen as the final step in creating a reconstructed breast which closely resembles the original. Multiple surgical techniques, of varying complexity and usefulness, are available for NAC reconstruction. The principal criterion for successful NAC reconstruction is symmetry of position, size, colour, and projection. This study evaluates patients’ subjective satisfaction following NAC reconstruction and dermal tattooing, as well as objective comparison of colour match. Two techniques for NAC reconstruction were used; the modified star flap (n = 18) or the skate flap (n = 8) with full thickness skin grafting. All patients undergoing NAC reconstruction were surveyed via questionnaire and asked to rate their satisfaction using a standard scale. Objective colour matching was carried out using a computer programme to compare post-tattooing photographs. Patient satisfaction was rated as very good or excellent for position, size, and colour match in all cases. There was no difference between those who had star flap or skate flap reconstructions. There was, however, a lower satisfaction with projection amongst those who had undergone skate flaps. This study shows a high level of patient satisfaction and good colour match following NAC reconstruction and dermal tattooing.

Nipple-areolar complex (NAC) reconstruction can be broadly categorized into surgical reconstruction, tattooing, or both. NAC tattooing has shown continued advances recently, resulting in increased discussion of tattoo-only methods within the literature. This study aims to quantify recent trends in choice of NAC reconstruction and explore driving factors. Patients who underwent postmastectomy breast and NAC reconstruction between January 2007 and December 2021 at a single academic institution were reviewed and grouped based on method of NAC reconstruction: (1) surgical-only, (2) tattoo-only, and (3) both surgical and tattoo. Trends were assessed in each group using Poisson regression. The study included 138 patients; 17.4% (n = 24) were in the surgical-only group, 16.7% (n = 23) tattoo-only, and 65.9% (n = 91) both surgical and tattoo. Over the 15-year period, patients receiving tattoo-only NAC reconstruction significantly increased (β = 0.173, P < 0.0001), while those receiving both surgical and tattoo significantly decreased (β = -0.064, P = 0.007). There were no significant changes in surgical-only (β = 0.013, P = 0.563) or total (any type) NAC reconstruction (β = -0.013, P = 0.503). Rates of breast reconstruction significantly increased (β = 0.062, P < 0.0001). Variables such as autologous versus implant-based, unilateral versus bilateral, revision number, and radiation were stable over time and were not significantly associated with NAC reconstruction method. There is a significant trend toward tattoo-only and away from surgical-only reconstruction over the past 15 years, highlighting the importance of access to tattoo-based NAC reconstruction as part of comprehensive breast reconstruction care. The less invasive nature of tattooing and increase in tattoo quality are possible reasons for the increase in popularity.

27 - Reconstruction of the nipple areolar complex

Breast cancer is a prevalent cancer worldwide, leading many women to undergo mastectomy and breast reconstruction surgery. Nipple-areolar complex (NAC) reconstruction is critical in achieving aesthetic and psychological satisfaction. Recently, 3-dimensional (3D) NAC tattooing has become an option for this purpose. The aim of this study was to evaluate patient-reported outcomes for satisfaction among Hispanic women who underwent NAC reconstruction with 3D tattooing after breast reconstruction. Data were collected from a retrospective database covering a number of academic settings between 2014 and 2024. Participants were Hispanic women aged 32 to 60 years who had undergone various NAC reconstruction techniques. Follow-up was conducted no more than 6 months after surgery, utilizing the BREAST-Q version 2.0 questionnaire to measure satisfaction in 2 groups: Group 1, in which patients received alternative NAC reconstruction methods; and Group 2, which received 3D NAC tattooing. Patients who underwent 3D NAC tattooing (Group 2) demonstrated increased psychosocial well-being, with a mean [standard deviation] score of 84.73 [8.56]. Regarding surgeon experience, Group 2 achieved a mean score of 86.21 [10.33], which was lower than the Group 1 mean of 88.70 [10.78]. Notably, Group 2 expressed greater satisfaction with nipple reconstruction, with a mean score of 3.73 [0.44] compared with the Group 1 mean score of 3.48 [0.65]. The findings indicate that 3D NAC tattooing may enhance aesthetic outcomes of the NAC and psychosocial well-being in Hispanic women. This highlights the importance of incorporating unique techniques in breast reconstruction and the need for a multidisciplinary approach.

Nipple-areola complex (NAC) reconstruction is an important part of breast reconstruction. Although several techniques for NAC reconstruction have been described in the literature, the long-term outcomes after NAC reconstruction remain less satisfactory, especially following implant-based breast reconstruction. The authors reported their newly developed technique for NAC reconstruction in implant-based breast reconstruction. The authors describe their modified skate flap, by preserving more dermal tissues from the skate flap, for NAC reconstruction, following implant-based breast reconstruction. Additional derma-fat grafts, harvested from the full-thickness skin graft site, are also added to the reconstructed nipple to ensure long-term shape, size, and projection of the reconstructed nipple. A total of 30 patients underwent such a NAC reconstruction after successful implant-based breast reconstruction by the senior author. The minimum follow-up time was 1 year. No significant surgical complications have been observed in their series of 30 patients, and only a minor office procedure was performed subsequently in 6 patients (4 unilateral and 2 bilateral) to improve the shape of the reconstructed nipple. During a minimum of a 1-year follow-up period, outcomes with the authors’ technique in 30 patients are satisfactory; good size, shape, and projection of the reconstructed nipple are maintained. The long-term outcome of NAC reconstruction after implant-based breast reconstruction can be optimized with their modified skate flap by using all available flap tissue and with the addition of derma-fat grafts. The authors’ technique can be used safely for NAC reconstruction after implant-based breast reconstruction with good outcome and high patient satisfaction.

Nipple–areola complex reconstruction improves psychosocial and sexual well-being in women treated for breast cancer

Background:We report a technique of immediate nipple-areolar complex (NAC) reconstruction for patients undergoing skin-sparing mastectomy and implant-based breast reconstruction or therapeutic mammoplasty with central excision.Methods:Immediate nipple reconstruction is performed using a modified C-V flap planned along the edge of the incision. The areola is reconstructed using a full-thickness skin graft taken from skin usually discarded during the procedure. Immediate NAC reconstruction using this technique was performed on 32 breasts in 21 patients. This included 19 risk-reducing mastectomies, 9 therapeutic mastectomies, and 2 major revisions to existing implant reconstruction. Reconstruction was direct to implant in 29 breasts and by expander in 1 breast. The device was placed in a pre- or post-pectoral plane utilizing dermal sling and/or acellular dermal matrix as determined on a case-by-case basis. Immediate NAC reconstruction was also performed on 2 patients undergoing therapeutic mammoplasty with central excision.Results:Mean follow-up is 12 months (5–27 months), and cosmetic results have been good. There have been no significant complications, and no revisional surgery has been required.Conclusion:The application of simple techniques for NAC reconstruction in the primary procedure allows reconstruction of the whole breast in a single stage. There is an immediate focal point to the reconstruction to improve cosmesis, patient satisfaction, and psychosocial function without delay.

Breast reconstruction using DIEP flap: The free flap alone be enough? Quality of life and satisfaction analysis after complementary surgeries

Nipple areola complex (NAC) reconstruction is the final stage in breast reconstruction for many women. Although general population preferences on NAC aesthetics and sensation have been studied, it is unclear if these preferences align with the preferences of women who have undergone mastectomy. Therefore, this study aimed to assess the aesthetic and sensory preferences of women who have undergone mastectomy to inform subsequent NAC reconstruction and neurotization. We conducted a cross-sectional, Facebook-based, crowdsourcing campaign to distribute a survey on NAC aesthetics (e.g., position, size, pigmentation) and sensation to women with a history of mastectomy. Analyses assessed aesthetic and sensory preferences stratified by breast shape. We received 109 responses from women with a median age of 51 years (interquartile range, 47-58 years). Most women were White (94%) and married (68%), with more than a high school education (83%) and a family income of $100,000 or more (39%). Their surgical histories included mastectomy (n = 109, 100%), autologous breast reconstruction (n = 59, 54.1%), implant-based breast reconstruction (n = 49, 45.0%), and NAC reconstruction (n = 26, 23.7%). On round breasts, respondents preferred NACs positioned in the middle of the vertical axis and laterally on the horizontal axis. On teardrop-shaped breasts, respondents preferred inferolateral NAC positioning. The most popular NAC diameter was one third the base width of the breast. Respondents preferred NAC pigmentation one shade darker than skin tone. Respondents indicated that NAC appearance, tactile sensation, and erogenous sensation were more important for sexuality and quality of life than for self-esteem, body image, or gender identity. Optimal NAC aesthetics included a NAC one third the base width of the breast, pigmented one tone darker than skin tone, and positioned in the middle of the vertical axis and laterally on the horizontal axis on round breasts or inferolaterally on teardrop-shaped breasts.

Tattoo-only nipple-areola complex reconstruction: Another option for plastic surgeons

21 - Nipple–Areola Complex Reconstruction

One-stop autologous breast reconstruction: A safe and effective cost-saving pathway

Given the multiple possible scar patterns in autologous breast reconstruction and combinations of such patterns in bilateral reconstruction, the present study aimed to determine the importance of scar symmetry in achieving aesthetically pleasing results. A survey was administered to 128 participants including plastic surgeons and female breast reconstruction patients. In part A of the survey, participants were provided with photos of bilateral autologous breast reconstructions, and scar placement was varied to represent bilateral (1) immediate, (2) delayed symmetric, (3) delayed asymmetric, and (4) a mixture of immediate and delayed free flap reconstructions. Participants were asked to rank the photos in order of best to worst aesthetic outcome. In part B, pairs of the same reconstruction before and after nipple-areolar complex (NAC) reconstruction were presented, and participants were asked to assign a score to each photo according to aesthetic outcome. In part A, immediate reconstructions that included the smallest flap skin paddles ranked best among 52.5% ± 30% of participants, followed by delayed symmetric reconstructions that ranked best in 46.7% ± 29.6%. Mixed reconstructions ranked worst among 53.6% ± 37.6% of participants, followed by delayed asymmetric reconstructions (42.5% ± 37.9%). When NAC reconstruction was added to 1 set of the photos in part A, the same immediate reconstruction was ranked best, a significantly higher proportion of the time (36.3% increase, P < 0.001). This was accompanied by a significant decrease in top ranking for the delayed symmetric reconstruction (37.9% decrease, P < 0.001). In part B, addition of NAC increased each reconstruction's score by an average of 1.36 points on a 5-point scale with patients citing less improvement between the conditions (0.93 ± 0.03) than plastic surgeons (1.13 ± 0.49) (P = 0.03). More symmetric breast scars led to higher aesthetic ranking of bilateral autologous breast reconstructions. Participants in our survey preferred symmetric scars, even if achieving such a scar pattern would require excision of native breast skin and inclusion of more flap skin. Furthermore, NAC reconstruction alone improves aesthetic outcome, and improvement was most notable among immediate reconstructions.

Nipple-areola complex (NAC) reconstruction is the final critical process used to achieve breast symmetry, patient satisfaction, and overall reconstruction completeness. Here, we introduce our simplified simultaneous NAC reconstruction approach with nipple sharing and tattooing that resulted in minimal morbidity, high patient satisfaction, and a shortened total reconstructive period. Patients who underwent simultaneous nipple sharing and tattooing between July 2012 and December 2017 after the final operative procedure or adjuvant therapy were included. We retrospectively evaluated breast reconstruction type, interval between breast and NAC reconstruction, mean operation time for simultaneous nipple sharing and tattooing, and postoperative complications. Overall patient satisfaction and willingness to undergo simultaneous NAC reconstruction again were assessed. The mean interval between the final operative procedure or adjuvant therapy and NAC reconstruction was 4.4, 4.4, and 6.7months in non-adjuvant patients, those who underwent chemotherapy, and those who underwent radiotherapy, respectively. The mean operation time for simultaneous NAC reconstruction was 46min. No major complications such as infection or total nipple loss were observed regardless of breast reconstruction type at least 6months postoperatively. The average overall satisfaction was 8.0 on a 10-point scale, and 96.9% of patients indicated that they would undergo this simultaneous NAC reconstruction again. Our simplified technique of simultaneous nipple sharing and tattooing is safe and reliable and features high patient satisfaction rates. Additionally, it can be performed in the clinical setting and is convenient for patients and surgeons alike since it features a decreased total reconstruction period. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .