title: Nipple-areola complex reconstruction techniques: A literature review.
abstract: Many techniques for nipple-areola complex (NAC) reconstruction are described. Clarity is required on the currently available options. Since a complete list of all the techniques described until now is not available, a possibly comprehensive literature overview was carried out from 75 papers (years 1946-2015). The local flap was the most frequently described technique for the nipple reconstruction with no significant difference in complications' rate among the various types of techniques. Complications in nipple reconstruction were 46.9% after graft, 7.9% after local flap, and 5.3% in case of flaps with autologous graft/alloplastic/allograft augmentation, while complications in areola reconstruction were 10.1% after graft, and 1.6% after areola tattoo. Flaps appear to be more reliable than grafts in nipple reconstruction, while tattoo is thought to be safer than graft in areola reconstruction. The loss of projection, although considerable (45%-75%), had not significant impact on patients' satisfaction. Due to contraction, overcorrection of 25-50% of the desired result is advisory when adopting local flaps, in order to prevent loss of projection. The use of flaps with autologous graft/alloplastic/allograft augmentation (cartilage, fat, calcium hydroxylapatite, acellular dermal matrix, polymethylmethacrylate, biologic collagen) showed a minor loss of nipple projection but may expose to a relative increased number of postoperative flap necrosis.
authors: Plastic Surgery Division, General and Specialist Surgery Department, University of Siena, Siena, Italy. Electronic address: asisti6@gmail.com.
authors: A
authors: A
authors: Sisti
authors: Plastic Surgery Division, General and Specialist Surgery Department, University of Siena, Siena, Italy.
authors: L
authors: L
authors: Grimaldi
authors: Plastic Surgery Division, General and Specialist Surgery Department, University of Siena, Siena, Italy.
authors: J
authors: J
authors: Tassinari
authors: Plastic Surgery Division, General and Specialist Surgery Department, University of Siena, Siena, Italy.
authors: R
authors: R
authors: Cuomo
authors: Plastic Surgery Division, General and Specialist Surgery Department, University of Siena, Siena, Italy.
authors: L
authors: L
authors: Fortezza
authors: Department of Plastic Surgery, University of Turin, San Giovanni Battista Hospital, Turin, Italy.
authors: M A
authors: MA
authors: Bocchiotti
authors: Oncologic Surgery, General and Specialist Surgery Department, University of Siena, Siena, Italy.
authors: F
authors: F
authors: Roviello
authors: Plastic Surgery Division, General and Specialist Surgery Department, University of Siena, Siena, Italy.
authors: C
authors: C
authors: D'Aniello
authors: Plastic Surgery Division, General and Specialist Surgery Department, University of Siena, Siena, Italy.
authors: G
authors: G
authors: Nisi
mesh_terms: D062088:Acellular Dermis; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D009558:Nipples / Q000601:surgery*; D017060:Patient Satisfaction; D016038:Skin Transplantation / Q000379:methods*; D013524:Surgical Flaps
keywords: Local flaps; Nipple-areola reconstruction; Tissue grafts