Immediate Nipple Reconstruction and Maintenance of Breast Mound Projection in Free TRAM Flaps

The breast can be defined aesthetically by two criteria; the mound and the nipple-areolar complex. The advances of microsurgery allow excellent immediate results in creating a natural, aesthetic, and symmetric breast mound. The authors presented a technique first introduced by Dr. L. Colen. They demonstrated a method for shaping the TRAM flap which allows for immediate nipple reconstruction, while maintaining a projecting breast mound. Flap tissue that would otherwise be discarded in the shaping of the TRAM flap is used to create the nipple. The details of this procedure have been recorded and were demonstrated with intraoperative video. The technique is reliable, adds little time to the operation, and provides aesthetically pleasing results. Immediate nipple reconstruction in this setting avoids a second operative procedure and shortens the average reconstructive period. This technique has been employed in nearly one third of the free TRAM reconstructions in the last ten months at the authors' institution (18/64). Immediate nipple reconstruction shortens the reconstructive process, uses the TRAM flap to its maximal potential, provides improved projection, and creates good symmetry.