title: Nipple areola reconstructing reduction mammaplasty.
abstract: BACKGROUND
  The pigment density and texture of breast skin are not uniform. Especially in patients with massive breasts, lower pole skin can be significantly darker and coarser than the upper pole skin. Nipple areola reconstructing (NAR) reduction mammaplasty is a technical modification of the "free nipple" procedure in which the original nipple areola complex (NAC) is discarded and the new NAC is reconstructed from coarse pigmented lower pole skin using a modified skate flap purse-string technique.
  
  
  OBJECTIVE
  The authors review their initial clinical experience with NAR reduction mammaplasty.
  
  
  METHODS
  Between 2010 and 2012, 16 patients (31 breasts) underwent the NAR procedure, and these cases were retrospectively reviewed for patient demographics, preoperative topographic breast measurements, amount of reduction per breast, and complications. The operative goal was to obtain the smallest breast size that can be achieved with tension-free wound closure. Patient satisfaction was also assessed.
  
  
  RESULTS
  Breast reductions varied from 1150 to 2850 g/breast (average, 1590 g/breast), and patients were followed up for a minimum of 1 year (average, 15.9 months). No major local or systemic complications were encountered. Two patients required touch-ups for the correction of minor periareolar irregularities resulting mainly from the inversion of wound closure. At 1 year, average score for general satisfaction was 4.6, and the average score for NAC satisfaction was 3.9, on a scale from 1 (not satisfied) to 5 (extremely satisfied).
  
  
  CONCLUSIONS
  NAR reduction mammaplasty enables the surgeon to perform massive reductions, design different non-NAC-bearing glandular pedicles for breast shaping, and obtain tension-free closure without the fear of ischemic complications.
authors.affiliation: Dr Bitik is an Attending Surgeon, Department of Plastic Surgery, Hacettepe University Faculty of Medicine, Sihhiye, Ankara, Turkey, and Adjunct Staff, Department of Plastic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Ozan
authors.initials: O
authors.lastname: Bitik
authors.forename: Hakan
authors.initials: H
authors.lastname: Uzun
authors.forename: James E
authors.initials: JE
authors.lastname: Zins
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D009558:Nipples / Q000601:surgery*; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000009:adverse effects; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: breast reduction; free nipple; mammaplasty; nipple-areola reconstruction