Background: Despite the improved appearance associated with skin-sparing mastectomy, removal of the nipple-areola complex has a negative impact on the patient. Still, nipple-areola complex-sparing mastectomy results in preservation of a substantial amount of mammary tissue at risk. This may be prevented by preservation of the nipple-areola complex as a graft that is temporarily banked (e.g., in the groin region).
Methods: Ninety-seven nipple-areola complexes were banked as part of preventive (n = 62) or therapeutic (n = 35) skin-sparing mastectomies in 61 women with a median age of 41 years (range, 27 to 59 years) and a minimum follow-up of 2 years. The areola was harvested as a full-thickness skin graft with the nipple attached as a composite graft. In oncologic cases, the nipple-areola complexes were banked only after frozen section clearance.
Results: Seventy-five nipple-areola complexes were replanted onto the reconstructed mammary mound after 10 months (range, 3 to 26 months). Repeated graft take was moderate to good in 73 of these 75 nipple-areola complexes. The projection of the nipple and pigmentation of the areola were moderate to good in 45 and 74 of the 75 repeatedly transplanted grafts, respectively.
Conclusions: In skin-sparing mastectomy, maximum oncologically safe conservation of autologous mammary structures can be realized by means of temporary banking of the nipple-areola complex. Even though such banking may not be successful in all women, it proved to be satisfactory in most.
CODING PERSPECTIVE FOR THIS ARTICLE IS ON PAGE 538.
Amsterdam, The Netherlands
From the Departments of Plastic and Reconstructive Surgery, Psychosocial Counseling, and Psychosocial Research and Epidemiology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital.
Received for publication April 11, 2010; accepted July 21, 2010.
Disclosure: The authors have no financial interest to declare in relation to the content of this article.
J. Joris Hage, M.D., Ph.D.; Department of Plastic and Reconstructive Surgery; Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital; Plesmanlaan 161; NL-1066 CX Amsterdam, The Netherlands; firstname.lastname@example.org