Abstract
Purpose: This article identifies the advantage and disadvantage of a free nipple areola complex graft (FNACG) for nipple malposition which resulted from tissue-expander insertion and subsequently replaced with an implant after nipple sparing mastectomy (NSM). Methods: The subjects were three such patients treated using FNACG and who were followed up for at least one year postoperatively. The surgical outcome was assessed for symmetry of nipple-areola position, graft take, depigmentation, and shrinkage. Results: In all patients, the graft was accurately transferred to a position to achieve symmetry with the unaffected breast, and there was complete graft take in the areola by simple surgical design and techniques. No depigmentation of the areola was observed. The size of the areola was almost unchanged after grafting in two patients, but areolar shrinkage occurred in one other patient. There was complete graft take in the nipple in one patient and no depigmentation of the nipple was observed. Necrosis occurred at the tip of the nipple in two other patients. These patients had depigmentation, and the height of nipples decreased in proportion to the level of necrosis. Conclusion: FNACG can be a useful method if its advantages and disadvantages are well considered.
Highlights
Many women who undergo breast cancer surgery face anxiety and fear toward cancer and are affected by the sense of loss of their breasts
This article identifies the advantage and disadvantage of a free nipple areola complex graft (FNACG) for nipple malposition which resulted from tissue-expander insertion and subsequently replaced with an implant after nipple sparing mastectomy (NSM)
There is a method in which a tissue expander is inserted and the skin on the cranial aspect is inflated to lower the high-riding nipple-areola complex [3]
Summary
Many women who undergo breast cancer surgery face anxiety and fear toward cancer and are affected by the sense of loss of their breasts. Nipple sparing mastectomy (NSM) tends to be selected in patients who want to preserve their nipples and areolas and for whom this treatment is indicated [1]. In NSM, the resected breast tissue needs to be replaced with autologous tissue in a single-stage surgery. Nipple-areola complex malposition occurs due to contraction of the skin and changes to the breast volume. Patients are placed in an unexpected situation of facing breast cancer, and some of them are unprepared to decide at the stage of breast cancer surgery whether they want to use autologous tissue to reconstruct their breasts. A tissue expander is often inserted at the site of the breast tissue resection in NSM. There have been many reports on surgical methods to correct nipple-areola complex malposition. This article identifies the advantage and disadvantage of a free nipple areola complex graft (FNACG) [2]
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