Abstract
Nipple-Areolar Complex (NAC) reconstruction represents the final, concluding journey of breast reconstruction by being able to give to reconstructed breasts the shape of a natural breast mound. Nevertheless an enormous amount of nipple reconstruction techniques are described in literature, given the fact that most reconstructive options fail to give satisfactory outcomes in relation to the long-term nipple projection. In this review, the authors will browse most common nipple reconstruction techniques, taking into account: Indication, outcome, and side effect. Composite nipple grafts, traditional flaps, flaps with autologous graft augmentation, flaps with allograft augmentation, and flaps with alloplastic augmentation are the main strategies employed nowadays. Composite nipple grafts give the best guarantee of color-texture match with the contralateral side and show satisfactory nipple projection even at long-term follow-up. Skate, star, C-V, and arrow flap are by far the most commonly employed and the most reliable local flaps, however loss of projection of up to 70 percent are reported in literature. Alloplastic grafts were associated with the lowest rates of projection loss followed by autologous and allogenic ones. Nevertheless allogenic grafts are also associated with the highest complication rate, while autologous and allogenic ones have similar rates. Infection, seroma, and fat necrosis are the more commonly reported complications of autologous grafting along with donor site morbidity, while allogenic and alloplastic augmentation grafts may also experience the risk of overcorrection and graft exposure. Given the numerous techniques described in literature it is clear that the ideal nipple reconstruction hasn’t been found yet. Whereas it should be chosen on case to case basis depending on type of mastectomy, radiotherapy, type of reconstruction, skin thickness, tissue condition, and patients’ expectations to ensure the best cosmetic outcome.
Highlights
Nipple-Areolar Complex (NAC) reconstruction represents the final, concluding journey of breast reconstruction [1]
Nipples have an average 1.3 cm diameter, 0.9 cm high, and nipple-areola ratio of approximately 1:3 [4]. These measures can be helpful in patients that underwent bilateral breast reconstructions, while the contralateral side guides the reconstructive strategy in monolateral ones
Most NAC reconstruction follow its loss as consequence of breast cancer, but it can be caused by trauma, congenital absence, burn deformities, and complications from breast surgeries [1]
Summary
Nipple-Areolar Complex (NAC) reconstruction represents the final, concluding journey of breast reconstruction [1]. Despite being the less technically challenging step of breast reconstruction, it is of great concern for patients from an aesthetic and psychological point of view [2]. Recreated NAC can give to reconstructed breasts the shape of a natural breast mound. NAC reconstruction can be done anytime and following any type of breast reconstruction strategy. An enormous amount of nipple reconstruction techniques and approach can be found in literature, given the fact that most reconstructive options fail to give satisfactory outcomes in relation to the long-term nipple projection [3]
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