title: Revisiting the free nipple graft: an opportunity for nipple sparing mastectomy in women with breast ptosis.
abstract: OBJECTIVE
  Nipple areolar complex (NAC) sparing mastectomy improves the cosmetic outcome of patients with breast cancer. However, women with significant breast ptosis are not candidates for this technique due toexcessive skin flap length and ensuing risk of NAC ischemia.1 (-) 3 We report a novel technique using free nipple graft during skin sparing mastectomy for patients with significant ptosis while concurrently maintaining oncologic integrity.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Community and tertiary care hospital practices.
  
  
  METHODS
  Women with breast cancer desiring NAC preservation who are otherwise candidates for nipple sparing mastectomy, but with significant breast ptosis that precludes NAC viability. All women underwent immediate, autologous breast reconstruction.
  
  
  METHODS
  Bilateral and unilateral free nipple grafts were harvested, placed on ice during skin sparing mastectomy and free flap reconstruction, grafted at the conclusion of the case and secured with a bolster.
  
  
  METHODS
  Full or partial NAC preservation, ischemia time, local wound complications at NAC grafting site, pathologic outcomes.
  
  
  RESULTS
  A total of three patients underwent free nipple grafting at the time of skin sparing mastectomy and free or pedicled flap for breast cancer between March and September 2012. Of five total nipple grafts, one had partial NAC loss but did not require operative debridement. Pathologic review of areolar tissue removed during intraoperative defatting of free nipple graft demonstrated residual duct epithelium.
  
  
  CONCLUSIONS
  Women with significant breast ptosis that would preclude them from NAC sparing mastectomy can successfully preserve their NAC using a free nipple graft. Duct epithelium present in defatted tissue during preparation of the free nipple graft suggests that oncologic integrity can also be maintained.
authors: Department of Plastic Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA. jrchidester@gmail.com
authors: Jeremy R
authors: JR
authors: Chidester
authors: Andrea O
authors: AO
authors: Ray
authors: Sharon S
authors: SS
authors: Lum
authors: Duncan C
authors: DC
authors: Miles
mesh_terms: D001941:Breast Diseases / Q000601:surgery*; D005260:Female; D006801:Humans; D016462:Mammaplasty; D008408:Mastectomy; D009558:Nipples / Q000601:surgery*; D011379:Prognosis; D013524:Surgical Flaps