One-stage nipple and breast reconstruction following areola-sparing mastectomy

Abstract

Background: Skin-sparing mastectomy with immediate breast reconstruction is increasingly becoming a proven surgical option for early-stage breast cancer patients. Areola-sparing mastectomy (ASM) has also recently become a popular procedure. The purpose of this article is to investigate the reconstructive and aesthetic issues experienced with one-stage nipple and breast reconstruction using ASM.

Methods: Among the patients who underwent mastectomy between March 2008 and March 2010, 5 women with a low probability of nipple-areolar complex malignant involvement underwent ASM and immediate breast reconstruction with simultaneous nipple reconstruction using the modified C-V flap. The cosmetic outcomes of this series were reviewed by plastic surgeons and patient self-assessment and satisfaction were assessed via telephone interview.

Results: During the average 11-month follow-up period, there were no cases of cancer recurrence, the aesthetic outcomes were graded as excellent to very good, and all of the patients were satisfied. Two patients developed a gutter-like depression around the reconstructed nipple, and one patient developed skin erosion in a small area of the areola, which healed with conservative dressing. The other complications, such as necrosis of the skin flap or areola, seroma, hematoma, or fat necrosis did not occur.

Conclusions: Since one-stage nipple and breast reconstruction following ASM is an oncologically safe, cost-effective, and aesthetically satisfactory procedure, it is a good surgical option for early breast cancer patients.

Keywords: Breast; Mammaplasty; Mastectomy; Nipples.

Fig. 1

Diagram of one-stage nipple and breast reconstruction (A) Incision line for areolar-sparing mastectomy. (B) Diagram after areolar-sparing mastectomy. (C) Design for modified C-V flap (thin linear arrow) and the area of deepithelization (thick black arrow) of the remnant skin paddle of the flap after insetting of the latissimus dorsi muscle or transverse rectus abdominis myocutaneous flap. The white thick arrow shows the remaining areola before closing the wound. (D) Vertical cross section. The arrows indicate the same as that in Fig. 1C.

Fig. 2

Photograph of one-stage nipple and breast reconstruction A 32-year-old female underwent immediate TRAM flap breast reconstruction after ASM of the left breast through 2-cm-long incisions on both the sides of the areola. The nipple was simultaneously reconstructed using the modified C-V flap from the skin paddle of a TRAM flap. TRAM, transverse rectus abdominis myocutaneous; ASM, areola-sparing mastectomy.

Fig. 3

Preoperative and postoperative photographs of case 1 (A) Preoperative view. (B) Eighteen-month postoperative view after immediate transverse rectus abdominis myocutaneous flap breast reconstruction and modified C-V flap nipple reconstruction following areola-sparing mastectomy of the right breast. There was a gutter-like depression around the reconstructed nipple (white arrow).

Fig. 4

Preoperative and postoperative photographs of case 2 (A) Preoperative view. The patient had already undergone conventional mastectomy of the left breast with immediate transverse rectus abdominis myocutaneous flap breast reconstruction. (B) Six-month postoperative view after immediate latissimus dorsi muscle flap breast reconstruction and modified C-V flap nipple reconstruction following areola-sparing mastectomy of the right breast.