One-stage nipple and breast reconstruction using a deep inferior epigastric perforator flap after a skin-sparing mastectomy

Background Nipple reconstruction is usually performed as a delayed procedure in patients with breast cancer who undergo skin-sparing mastectomy and breast reconstruction surgery using a deep inferior epigastric perforator (DIEP) flap. The authors designed this study to evaluate the utility of breast reconstruction based on a DIEP flap and immediate nipple reconstruction.

Methods A retrospective review was conducted of all patients who underwent breast reconstruction performed by a single plastic surgeon from October 2016 to June 2018. Through a questionnaire and chart review, we compared surgical results and complications in cases of single-stage nipple reconstruction after skin-sparing mastectomy (n=17) with patients who underwent delayed nipple reconstruction after skin-sparing mastectomy, modified radical mastectomy, or simple mastectomy (n=7).

Results In a subjective analysis using clinical photos, the immediate nipple reconstruction group had higher scores than their counterparts in an evaluation of the nipple-areolar complex (NAC) (NAC placement, 3.34 vs. 3.04; nipple projection, 3.05 vs. 3.03; nipple size, 3.30 vs. 3.29). No significant differences between the groups were found in terms of complications.

Conclusions Simultaneous nipple reconstruction is a reliable surgical method with economic advantages. No differences were found in terms of outcomes and complications in comparison to delayed reconstruction. Therefore, surgeons can consider simultaneous nipple reconstruction without particular concerns about asymmetry or necrosis.

Keywords

Mammaplasty - Mastectomy - Nipples

This article was presented at PRS Korea 2018 on November 9-11, 2018, in Seoul, Korea.

Publication History

Received: 07 May 2019

Accepted: 24 October 2019

Article published online:
25 March 2022

• REFERENCES

• 1 Galimberti V, Vicini E, Corso G. et al. Nipple-sparing and skin-sparing mastectomy: review of aims, oncological safety and contraindications. Breast 2017; 34 Suppl 1: S82-4
• 2 Tremp M, di Summa PG, Schaakxs D. et al. Nipple reconstruction after autologous or expander breast reconstruction: a multimodal and 3-dimensional analysis. Aesthet Surg J 2017; 37: 179-87
• 3 Kristoffersen CM, Seland H, Hansson E. A systematic review of risks and benefits with nipple-areola-reconstruction. J Plast Surg Hand Surg 2017; 51: 287-95
• 4 Sisti A, Grimaldi L, Tassinari J. et al. Nipple-areola complex reconstruction techniques: a literature review. Eur J Surg Oncol 2016; 42: 441-65
• 5 Nimboriboonporn A, Chuthapisith S. Nipple-areola complex reconstruction. Gland Surg 2014; 3: 35-42
• 6 Bykowski MR, Emelife PI, Emelife NN. et al. Nipple-areola complex reconstruction improves psychosocial and sexual well-being in women treated for breast cancer. J Plast Reconstr Aesthet Surg 2017; 70: 209-14
• 7 Satteson ES, Brown BJ, Nahabedian MY. Nipple-areolar complex reconstruction and patient satisfaction: a systematic review and meta-analysis. Gland Surg 2017; 6: 4-13
• 8 Williams EH, Rosenberg LZ, Kolm P. et al. Immediate nipple reconstruction on a free TRAM flap breast reconstruction. Plast Reconstr Surg 2007; 120: 1115-24
• 9 Yoon JS, Chang JW, Ahn HC. et al. Modified C-H flap for simultaneous nipple reconstruction during autologous breast reconstruction: surgical tips for safety and cosmesis. Medicine (Baltimore) 2018; 97: e12460
• 10 Hyza P, Streit L, Vesely J. et al. New technique of immediate nipple reconstruction during immediate autologous DIEP or MS-TRAM breast reconstruction. Ann Plast Surg 2015; 74: 645-51
• 11 Nahabedian MY. Nipple reconstruction. Clin Plast Surg 2007; 34: 131-7
• 12 Kim HR, Lim JS, Kim SM. et al. One-stage nipple and breast reconstruction following areola-sparing mastectomy. Arch Plast Surg 2013; 40: 553-8