Nipple reconstruction in autologous breast reconstruction after areola-sparing mastectomy

• Published in: Journal of plastic, reconstructive & aesthetic surgery reconstructive & aesthetic surgery, 2021-06, Vol.74 (6), p.1223-1228
• Main Authors: Opsomer, Dries, Vyncke, Tom, Depypere, Bernard, Stillaert, Filip, Van Landuyt, Koenraad, Blondeel, Phillip
• Format: Article
• Language: English
• Subjects: Microsurgery; Patient reported outcomes
• ISSN: 1748-6815; 1878-0539
• DOI: 10.1016/j.bjps.2020.10.082

The number of patients requesting prophylactic mastectomy with immediate reconstruction is rising. The oncological safety of techniques preserving the nipple and/or areola complex is still controversial. Nevertheless, nipple-sparing mastectomy (NSM) and areola-sparing mastectomy (ASM) are becoming increasingly popular. After ASM, traditional nipple reconstruction techniques can be a disappointment and can lead to a deep groove around the new nipple. We describe a technique to overcome these issues and analyzed how three types of mastectomy (skin-sparing mastectomy or SSM, ASM, and NSM) compare to one another by looking into the number of wound infections, extra procedures for the loss of projection, nipple necrosis, and BREAST-Q scores. We retrospectively analyzed 467 breast reconstructions performed in 351 patients between 2011 and 2017 at the University Hospital of Gent. Patients were asked to fill out the BREAST-Q questionnaire and patient-reported outcomes were analyzed and correlated to demographic information. Patients undergoing a nipple reconstruction after ASM are experiencing similar rates of wound problems, extra surgical procedures for the loss of projection and necrosis, compared to women with a history of SSM. When considering the “satisfaction with breast” and “satisfaction with outcome” modules of the BREAST-Q, we noted that nipple-sparing mastectomy (NSM) patients report lower scores than SSM and ASM patients and ASM patients seem to report a higher “satisfaction with nipple,” than the other two treatment groups. An ASM is a valuable alternative to a nipple-sparing mastectomy and leads to a good esthetic result and patient satisfaction.