Evaluating the Efficacy and Patient Satisfaction of Nipple-Areola Complex Reconstruction Using the Nipple-Sharing Technique and Perineal Skin Graft After Breast Reconstruction.

Abstract

The completion of nipple-areola complex (NAC) reconstruction is increasingly regarded as an essential final step in breast reconstruction. As the perineal skin of Asian females is commonly hyperpigmented, we investigated its use for areolar reconstruction in conjunction with a nipple-sharing procedure and evaluated surgeon- and patient-reported outcomes. This retrospective review focused on NAC reconstructions performed on patients with unilateral breast reconstruction. This study analyzed 15 cases in which NAC reconstruction was performed as a secondary procedure following initial breast reconstruction. The employed technique involved the "nipple-sharing" approach complemented by a full-thickness skin graft harvested from the perineum. Key metrics for assessment included patient age, type of initial breast reconstruction, complication rates, and parameters such as color, symmetry, projection, and overall satisfaction, which were evaluated using a 5-point Likert Scale by both patients and overseeing physicians. The series showed that all 15 NAC reconstructions yielded positive aesthetic outcomes. The take of full-thickness skin graft for areolar reconstruction was 100%. However, there were instances of minor to partial loss of the nipple graft in 7 cases after the removal of the tie-over dressing 7 days after operation. Nipple height showed no statistical significance (P = 0.167) compared to the normal side after 2 years of follow-up. Satisfaction levels regarding surgical outcomes were high among all patients. The study concludes that NAC reconstruction using the 'nipple-sharing' technique, combined with perineal skin grafting, is a reliable and effective method for the Asian population after long-term follow-up.