Nipple-Areola Complex Reconstruction
The reconstruction of the nipple-areola complex (NAC) is an integral part of breast cancer treatment after mastectomy or central quadrants, transforming the reconstructed mound into a breast. The final result becomes pleasing and natural. NAC reconstructi
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Francesca De Lorenzi, Benedetta Barbieri, and V. Lohsiriwat
55.1 Introduction
55.3 Where Is the Position of NAC?
The reconstruction of the nipple-areola complex (NAC) is an integral part of breast cancer treatment after mastectomy or central quadrants, transforming the reconstructed mound into a breast. The final result becomes pleasing and natural. NAC reconstruction has a positive psychological impact on breast cancer patient; it may cover part of the mastectomy scar [1]. However, not all women desire to complete the reconstruction, and generally older patients do not.
The planning of the new NAC should be performed with the patient in the upright position, being the opposite healthy breast used as a guide. Specific anatomical landmarks help to determine the proper position, such as the sternal notch, the midline, or the imaginary intersection line through the healthy nipple. The distance between the healthy spared areola (if present, not in bilateral reconstructions) and the sternal notch, inframammary fold, and midline can be measured to reproduce the ideal position on the reconstructed mound. More often, the new areola simply looks right, depending on the so-called a glance visual. Proper appearance takes precedence over measurements, which can merely confirm the accuracy of the visual positioning. Other advises regard the distance between the two nipples, which is maintained between 18 and 22 cm on average, therefore avoiding unaesthetic medial areola position. Moreover, the NAC should be positioned on the maximum projection of the reconstructed breast.
55.2 W hen to Perform the NAC Reconstruction? NAC reconstruction is generally planned at least 3–6 months after breast reconstruction either with definitive implants or flaps or after the contralateral symmetry procedure (if not performed simultaneously with the reconstruction). In fact, it should be delayed after breast reconstruction settled down to its final shape and position. In the earlier period, it is probably not possible to determine the right position of the new areola, resulting in disturbing asymmetries.
F. De Lorenzi (*) Division of Plastic Surgery, European Institute of Oncology, Milan, Italy e-mail: [email protected] B. Barbieri Divisione di Chirurgia Ricostruttiva, Division of Plastic Surgery, Milano, Italy V. Lohsiriwat Faculty of Medicine, Department of Surgery, Siriraj Hospital, Mahidol University, Bangkok, Thailand
55.4 How to Reconstruct the NAC? Several surgical techniques have been described over the past 30 years for the reconstruction of the NAC. The new NAC tissue can be harvested from local or distant tissues. There is also a combination of different methods, and it can be even combined with alloplastic material or filler injection. Each of these methods has its own advantages and limitations; most of them yield good results transiently, but in few cases nipple definition and projection are guaranteed with time. For these reasons no method has become the favorite. The decision between different methods dep
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