title: Immediate nipple reconstruction on a free TRAM flap breast reconstruction.
abstract: BACKGROUND
  Reconstruction of the nipple-areola complex is usually deferred until breast mound reconstruction is complete. The authors review their experience with a technique that allows for shaping of a free transverse rectus abdominis myocutaneous (TRAM) flap and immediate nipple reconstruction and compare this technique with delayed nipple reconstruction.
  
  
  METHODS
  A retrospective chart review demonstrated 21 patients who underwent immediate nipple reconstruction, 10 of whom had complete photographs and records for review. Ninety patients underwent delayed nipple reconstruction. Twenty of these patients were chosen for comparison, 15 of whom had complete photographs and records. Age, body mass index, comorbidities, procedures required, complications, and time to completion were reviewed. A multiobserver, multicharacteristic, standardized photographic review of cosmetic outcomes was conducted.
  
  
  RESULTS
  Time from mastectomy to completion of reconstruction, not including areolar tattooing, was 1 day (median) versus 125 days (median) in the immediate and delayed groups, respectively (p = 0.003). The number of procedures required to complete reconstruction before areolar tattooing was one (median) in the immediate group and two (median) in the delayed group (p < 0.001). Complication rates were similar in both groups. Subjective review demonstrated no difference in the aesthetic outcome of the breast mound or nipple-areola complex reconstruction.
  
  
  CONCLUSIONS
  Patients having immediate nipple reconstruction in the setting of a free TRAM breast reconstruction completed their reconstruction earlier, required fewer procedures, and had aesthetic results comparable to patients having traditional delayed nipple reconstruction. Complications and revision rates were comparable.
authors: Birmingham, Ala.; and Newark, Del. From the Department of Surgery, Division of Plastic Surgery, University of Alabama at Birmingham, and the Christiana Center for Outcomes Research.
authors: Eric H
authors: EH
authors: Williams
authors: Lawrence Z
authors: LZ
authors: Rosenberg
authors: Paul
authors: P
authors: Kolm
authors: Jorge I
authors: JI
authors: de la Torre
authors: R Jobe
authors: RJ
authors: Fix
mesh_terms: D000328:Adult; D004954:Esthetics; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D009558:Nipples / Q000601:surgery*; D012189:Retrospective Studies; D013524:Surgical Flaps; D013653:Tattooing; D013997:Time Factors