Immediate Reconstruction of the Nipple/Areola Complex in Oncoplastic Surgery After Central Quadrantectomy

Abstract

Background: 

Oncoplastic surgery adds valuable techniques for breast-conservation therapy that allows for wide excisions and prevents breast deformities. However, no such technique has addressed loss of the nipple/areola complex (NAC) after central lumpectomy. We present a simple and effective technique for immediate reconstruction of the NAC after such loss due to tumorectomy.

Methods: 

After central tumorectomy, a local tissue flap is created above the defect to restore the nipple. Then the neonipple is carried on a superior-based, dermoglandular pedicle to its new position, similar to breast reduction surgery. The operation is continued with resection of redundant tissue lateral to the pedicle for optimal breast shape. From the discarded breast tissue, a full-thickness skin graft is harvested and used to reconstruct the areola. The contralateral breast is treated with a usual mammaplasty and tailored to the specific needs of the opposite side.

Results: 

Nine patients with central tumors of the breast were treated in this fashion at our institution. In all patients, the aesthetic result was good to excellent. In 1 patient, there was delayed wound healing of the full-thickness skin graft for the areola, which healed by secondary intention.

Conclusion: 

The presented technique is easily achieved and produced excellent results after breast-conservation surgery. It will expand the armamentarium of oncoplastic surgery to meet central defects with loss of the nipple/areola complex.

In Brief

Nine central breast/nipple/areola resections for carcinoma were reconstructed using a modified Wise pattern reduction technique in which the nipple was reconstructed with small flaps either (1) superior to the excised NAC or (2) on the inferior pedicle. Areolar reconstruction was with a FTSG from the discarded breast skin.