Three-bladed flap combined with free skin graft for nipple-areola necrosis caused by iatrogenic reasons

Abstract

Objective To discuss the reasons of iatrogenic nipple-areola necrosis and to investigate clinical effect of nipple-areola reconstruction by three-bladed flap combined with free skin graft. Methods Between May 2012 and May 2015, 13 patients with nipple-areola necrosis caused by iatrogenic reasons were treated with our new method. We designed a skate flap on the new nipple site. After incising skin, three- bladed flap was cross-stitched to form a new nipple. New areola was reconstructed by free skin graft, which was obtained from perineum or contralateral areola, and margin of the donor area was sutured after proper free from surrounding tissues. Being deducted subcutaneous tissue, the full-thickness skin graft was sutured around the nipple just like letter O . After operation, the areola area was pressurized bandaging, and the nipple was drawn by silk at least one month. Results The incisions were all primary healing. Over a mean period of 8 months (range 6-18), all patients were satisfied with the results. No significant asymmetry occured. The average nipple retraction rate was 10.03%. In 13 patients, there was no infection, bleeding or hematoma and skin flap necrosis. Conclusions Nipple-areola necrosis occurs when the blood supply is not protected carefully during a breast plastic surgery. Therefore, we take full advantage of the scar tissue which has hyperpigmentation. Reconstructive nipple-areola complex has good shape, and there is no need to tattoo after operation. Key words: Nipple; Areola; Reconstruction; Skate flap; Scar; Skin graft