Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
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The oval technique for nipple-areolar complex reconstruction

  • Vozza, Amalia (Department of Plastic, Reconstructive and Aesthetic Surgery, Universita degli Studi della Campania Luigi Vanvitelli) ;
  • Larocca, Fabio (Department of Plastic, Reconstructive and Aesthetic Surgery, Universita degli Studi della Campania Luigi Vanvitelli) ;
  • Ferraro, Giuseppe (Department of Plastic, Reconstructive and Aesthetic Surgery, Universita degli Studi della Campania Luigi Vanvitelli) ;
  • Nicoletti, Giovanni Francesco (Department of Plastic, Reconstructive and Aesthetic Surgery, Universita degli Studi della Campania Luigi Vanvitelli) ;
  • D'Andrea, Francesco (Unit of Plastic, Reconstructive and Aesthetic Surgery, University of Naples Federico II)
  • Received : 2018.02.20
  • Accepted : 2018.09.12
  • Published : 2019.03.31
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Abstract

Background Nipple-areolar complex (NAC) reconstruction is the final stage of breast reconstruction. Ideal reconstruction of the NAC requires symmetry in position, size, shape, texture, pigmentation, and permanent projection, and although many technical descriptions of NAC reconstruction exist in the medical literature, there is no gold standard technique. The technique devised by the authors is very versatile, with excellent results, and it enables 1-step reconstruction with optimal results in terms of shape and nipple projection. Methods Our technique consists of a combination of modified local flaps and a full-thickness skin graft. Patients were observed for 18 months to estimate the amount of retraction. This procedure was performed in 40 patients, four of them bilaterally. The duration of the follow-up was 30 months. Complications occurred in 10% of patients, and included infections (5%), ischemia (2.5%), and hematoma (2.5%). Results No cases of total nipple necrosis were reported. The NAC shape remained optimal in all cases, with a very small reduction of the vertical and horizontal diameters of the areola, which maintained its designed round shape well, and negligible retraction in the diameter and projection of the nipple. Conclusions The oval technique represents a major step forward, involving a combination of existing techniques, such as the C-V flap and the cutaneous graft, to achieve excellent results regarding areola shape and nipple projection, significantly reducing the cases of nipple ischemia. These results were substantially obtained through subcutaneous equatorial sutures, skin grafting, and flattening of the apexes of the flap.

Keywords

References

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Cited by

  1. Nipple–Areola Complex Reconstruction vol.56, pp.6, 2019, https://doi.org/10.3390/medicina56060296