title: Patient satisfaction following nipple reconstruction incorporating autologous costal cartilage.
abstract: BACKGROUND
  Nipple-areolar reconstruction completes post-mastectomy breast reconstruction. Many techniques for nipple reconstruction have been described, and each has their advocates and critics. One of the frequent failings of most designs is loss of nipple projection with time.
  
  
  OBJECTIVE
  To determine the effect of including autologous costal cartilage on patient satisfaction with their nipple reconstruction.
  
  
  METHODS
  Sixty-eight patients were identified who had undergone fishtail flap nipple reconstruction following autologous free flap breast reconstruction between 1990 and 2004. Qualitative questionnaires, using Likert scales, were sent to each patient to specifically assess their satisfaction with their nipple reconstruction.
  
  
  RESULTS
  Of 26 respondents (mean +/- SEM follow-up period 3.7+/-3.6 years), 13 had undergone nipple reconstruction incorporating costal cartilage banked at the time of initial breast reconstruction, and the other 13 had no cartilage in their nipple reconstructions. While both groups would opt for nipple reconstruction again, patients with cartilage grafts incorporated into their reconstructions had overall satisfaction ratings 1.92 grades higher on average (not significant, P=0.12) than those without. This difference increased to 3.2 grades when the satisfaction of the patient's partner was taken into account (P<0.05). Improved satisfaction corresponded to higher scores for volume, consistency, texture, and particularly for projection and contour of the nipple (P<0.05). Although nipple morphology changed over time, there was a trend toward improved stability in the cartilage group.
  
  
  CONCLUSIONS
  Patient satisfaction with nipple reconstruction can be improved by incorporating costal cartilage beneath the skin flaps. Superior contour and projection are sustained over time.
authors: Division of Plastic Surgery and Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Ontario.
authors: Joan E
authors: JE
authors: Lipa
authors: Patrick D
authors: PD
authors: Addison
authors: Peter C
authors: PC
authors: Neligan