NIPPLE AREOLA COMPLEX RECONSTRUCTION AND FREE NIPPLE GRAFT

Preservation of the nipple-areola complex (NAC) is not always feasible due to tumor characteristics or patients’ comorbidities. In these circumstances, NAC reconstruction, often performed as the final phase of breast reconstruction, is optional but significantly enhances patient satisfaction and psycho-social well-being. NAC reconstruction aims to mimic the native NAC regarding position, projection, size, color, and texture. The NAC reconstruction technique should be simple, quickly applicable, and require fewer revisions. The timing and technique must consider the impact of adjuvant treatments on wound healing, as these treatments can affect reconstruction outcomes. Many techniques for NAC re-construction are described. Local flaps are the most commonly used technique for NAC reconstruction, offering a reliable approach with high satisfaction levels and low complication rates. Currently, more than 60 local flap procedures have been described for the reconstruction of nipple, but, an obvious superiority has not been demonstrated of one flap technique over the others. Despite their success, challenges such as loss of projection and flap contraction remain and may require revisions to im-prove long-term maintenance. The use of flaps with autologous/allogenic/synthetic grafts (cartilage, fat, calcium hydroxyapatite, acellular dermal matrix, polymethylmethacrylate, and biologic collagen) showed less loss of nipple projection, however, may be exposed relatively increased postoperative complications. Medical tattooing has become a standard technique for achieving realistic areola color and texture. Free nipple grafting is a good option for patients who have a history of periareolar incision, as well as for patients with large breasts, grade 2 or 3 ptosis, or a prior history of radiotherapy. Whilst various techniques are available for NAC reconstruction, no single approach has proven superior. The choice of technique often depends on the surgeon’s expertise and patient-specific factors.