title: Areola size and jugulum nipple distance after bilateral mastectomy and breast reconstruction.
abstract: OBJECTIVE
  The combination of a single pedicle local flap with tattooing for complete nipple areola complex (NAC) reconstruction is currently the most supported method. Although many technical descriptions of NAC reconstruction exist in the medical literature, there are no data that define the ideal areola size (diameter of the areola) after bilateral mastectomy and breast reconstruction considering the previous areola size.
  
  
  METHODS
  This was a 3-year (2009-2012) observational, analytical, and longitudinal prospective study with 103 patients who had undergone NAC tattooing as the last process of bilateral breast reconstruction after surgery for breast cancer. Statistical differences in the areola size and the jugulum-nipple distance before mastectomy and after reconstruction were analyzed by paired Student t tests with a 95% confidence interval.
  
  
  RESULTS
  The jugulum-nipple distance before mastectomy was 4.23 cm larger than after bilateral reconstruction (mean jugulum-nipple distance: 23.89 cm vs 19.66 cm), and for that reason shorter (more cephalad). The areola size before mastectomy was 1.59 cm larger than the one chosen by the patient for reconstruction (mean diameter of the areola: 5.25 cm vs 3.65 cm).
  
  
  CONCLUSIONS
  We conclude that, after bilateral mastectomy and reconstruction, the jugulum-nipple distance is smaller and women prefer smaller areola sizes.
authors: Service of Plastic, Aesthetic and Reconstructive Surgery, Reina Sofía University Hospital.
authors: Joaquín
authors: J
authors: Pérez-Guisado
authors: Consuelo
authors: C
authors: Rodríguez-Mérida
authors: Luis F
authors: LF
authors: Rioja
keywords: NAC tattooing; areola; breast cancer; breast reconstruction; mastectomy; nipple