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Management of the Nipple-Areola Complex in Selected Patients Undergoing Primary Breast Reconstruction: A Comparison of Immediate Replantation and Delayed Reconstruction

Nedomansky, Jakob MD; Nickl, Stefanie MD; Maier, Bernhard MD; Dubsky, Peter MD; Haslik, Werner MD; Schroegendorfer, Klaus F. MD

doi: 10.1097/SAP.0000000000000883
Breast Surgery

Background Management of the nipple-areola complex is an important issue in primary breast reconstruction. When nipple-sparing mastectomy is not suitable, alternatives are immediate nipple-areola complex replantation and delayed reconstruction. The aim of this study was to examine whether patients benefit more from nipple-areola complex preservation by immediate replantation or delayed nipple-areola complex reconstruction.

Methods Postoperative results and patient satisfaction after 54 primary breast reconstructions with immediate nipple-areola complex replantation or delayed nipple-areola complex reconstruction were retrospectively evaluated.

Results The nipple-areola complex was replanted immediately in 37 cases and reconstructed later with nipple sharing and full-thickness skin grafting in 17 cases. Compared with immediate replantation, delayed reconstruction resulted in significantly better postoperative nipple projection (P = 0.01*, Mann-Whitney U test), greater similarity of color and projection with the contralateral side and greater patient satisfaction (Breast-Q). Complete loss of projection occurred in 4 of the 37 replanted nipple-areola complexes. No complete nipple-areola complex necrosis or tumor recurrence was observed in any patient.

Conclusions Immediate nipple-areola complex replantation is a safe and reliable procedure for selected patients with contraindications for nipple-sparing mastectomy who have a strong desire to maintain their own nipple-areola complexes, or in bilateral cases. However, drawbacks of this procedure include loss of projection and depigmentation. Delayed reconstruction with nipple sharing and full-thickness skin grafting is a good alternative, especially in unilateral cases; it leads to better postoperative results and greater patient satisfaction, but it involves a nipple-areola complex-free period.

From the *Division of Plastic and Reconstructive Surgery, Department of Surgery, and †Department of Surgery, Comprehensive Cancer Center, Medical University of Vienna, Austria.

Received April 4, 2016, and accepted for publication, after revision June 22, 2016.

Conflicts of interest and sources of funding: none declared.

Reprints: Werner Haslik, MD, Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Austria, Waehringer Guertel 18–20, A-1090 Vienna, Austria. E-mail:

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