Immediate Nipple-Areolar Complex Reconstruction for Patients Undergoing Implant-Based Reconstruction or Therapeutic Mammoplasty

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.