Immediate Nipple-Areolar Complex Reconstruction for Patients Undergoing Skin Sparing Mastectomy and Implant Based Reconstruction or Therapeutic Mammoplasty
Association of Breast Surgery ePoster Library. Highton L. 05/15/17; 166216; P154
Ms. Lyndsey Highton
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Abstract
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Introduction
We describe a technique of immediate NAC reconstruction for patients undergoing skin sparing mastectomy and implant-based reconstruction or therapeutic mammoplasty following central excision.
Method
Nipple reconstruction is performed using a modified CV flap, planned at the correct height along the edge of the wise pattern or peri-areolar incision. A new areola is designed, de-epithelialised and reconstructed using a full thickness skin graft harvested from skin usually discarded. NAC tattooing may be performed at a later date if desired.
Results
We have performed this procedure on 32 breasts in 21 patients. This included 19 risk-reducing mastectomies, 9 therapeutic mastectomies, 2 therapeutic mammoplasties following central excision and 2 major revisions to existing implant reconstructions. The incision was wise pattern in 29 breasts and peri-areolar in 3 breasts. Reconstruction was direct to implant in 29 breasts and expander based in 1 breast, including a variety of techniques in either the pre or post pectoral plane and utilising dermal sling or ADM. There have been no significant complications. Mean follow up is 9 months (2-24 months). Cosmetic results have been excellent to date and no revisional surgery has been required.
Conclusions
Immediate NAC reconstruction is a reliable technique with good cosmetic outcomes. The application of simple techniques for NAC reconstruction in the primary procedure allows reconstruction of the whole breast in a single stage. There is an immediate focal point to the reconstruction to improve cosmesis, patient satisfaction and psychosocial function without delay, which is particularly beneficial for patients undergoing bilateral risk reducing mastectomies.
We describe a technique of immediate NAC reconstruction for patients undergoing skin sparing mastectomy and implant-based reconstruction or therapeutic mammoplasty following central excision.
Method
Nipple reconstruction is performed using a modified CV flap, planned at the correct height along the edge of the wise pattern or peri-areolar incision. A new areola is designed, de-epithelialised and reconstructed using a full thickness skin graft harvested from skin usually discarded. NAC tattooing may be performed at a later date if desired.
Results
We have performed this procedure on 32 breasts in 21 patients. This included 19 risk-reducing mastectomies, 9 therapeutic mastectomies, 2 therapeutic mammoplasties following central excision and 2 major revisions to existing implant reconstructions. The incision was wise pattern in 29 breasts and peri-areolar in 3 breasts. Reconstruction was direct to implant in 29 breasts and expander based in 1 breast, including a variety of techniques in either the pre or post pectoral plane and utilising dermal sling or ADM. There have been no significant complications. Mean follow up is 9 months (2-24 months). Cosmetic results have been excellent to date and no revisional surgery has been required.
Conclusions
Immediate NAC reconstruction is a reliable technique with good cosmetic outcomes. The application of simple techniques for NAC reconstruction in the primary procedure allows reconstruction of the whole breast in a single stage. There is an immediate focal point to the reconstruction to improve cosmesis, patient satisfaction and psychosocial function without delay, which is particularly beneficial for patients undergoing bilateral risk reducing mastectomies.
Introduction
We describe a technique of immediate NAC reconstruction for patients undergoing skin sparing mastectomy and implant-based reconstruction or therapeutic mammoplasty following central excision.
Method
Nipple reconstruction is performed using a modified CV flap, planned at the correct height along the edge of the wise pattern or peri-areolar incision. A new areola is designed, de-epithelialised and reconstructed using a full thickness skin graft harvested from skin usually discarded. NAC tattooing may be performed at a later date if desired.
Results
We have performed this procedure on 32 breasts in 21 patients. This included 19 risk-reducing mastectomies, 9 therapeutic mastectomies, 2 therapeutic mammoplasties following central excision and 2 major revisions to existing implant reconstructions. The incision was wise pattern in 29 breasts and peri-areolar in 3 breasts. Reconstruction was direct to implant in 29 breasts and expander based in 1 breast, including a variety of techniques in either the pre or post pectoral plane and utilising dermal sling or ADM. There have been no significant complications. Mean follow up is 9 months (2-24 months). Cosmetic results have been excellent to date and no revisional surgery has been required.
Conclusions
Immediate NAC reconstruction is a reliable technique with good cosmetic outcomes. The application of simple techniques for NAC reconstruction in the primary procedure allows reconstruction of the whole breast in a single stage. There is an immediate focal point to the reconstruction to improve cosmesis, patient satisfaction and psychosocial function without delay, which is particularly beneficial for patients undergoing bilateral risk reducing mastectomies.
We describe a technique of immediate NAC reconstruction for patients undergoing skin sparing mastectomy and implant-based reconstruction or therapeutic mammoplasty following central excision.
Method
Nipple reconstruction is performed using a modified CV flap, planned at the correct height along the edge of the wise pattern or peri-areolar incision. A new areola is designed, de-epithelialised and reconstructed using a full thickness skin graft harvested from skin usually discarded. NAC tattooing may be performed at a later date if desired.
Results
We have performed this procedure on 32 breasts in 21 patients. This included 19 risk-reducing mastectomies, 9 therapeutic mastectomies, 2 therapeutic mammoplasties following central excision and 2 major revisions to existing implant reconstructions. The incision was wise pattern in 29 breasts and peri-areolar in 3 breasts. Reconstruction was direct to implant in 29 breasts and expander based in 1 breast, including a variety of techniques in either the pre or post pectoral plane and utilising dermal sling or ADM. There have been no significant complications. Mean follow up is 9 months (2-24 months). Cosmetic results have been excellent to date and no revisional surgery has been required.
Conclusions
Immediate NAC reconstruction is a reliable technique with good cosmetic outcomes. The application of simple techniques for NAC reconstruction in the primary procedure allows reconstruction of the whole breast in a single stage. There is an immediate focal point to the reconstruction to improve cosmesis, patient satisfaction and psychosocial function without delay, which is particularly beneficial for patients undergoing bilateral risk reducing mastectomies.
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