Immediate nipple reconstruction during immediate autologous latissimus breast reconstruction

Background: Creation of the nipple-areola complex is the final step in surgical restoration of the breast. Often considered as a secondary complement to breast reconstruction, nipple-areola reconstruction is usually done after an interval of several months and makes use of composite graft techniques involving the opposite nipple or local flaps. Methods: Because the position of the nipple-areola complex is defined from the outset in skin-sparing mastectomy and because of the disappointing results obtained by classic nipple reconstruction techniques, the authors propose immediate nipple reconstruction using the skin paddle of the latissimus dorsi flap. Once the flap has been raised and placed in the skin-sparing mastectomy site, its paddle is folded back onto itself to form a cone. Two dermal-fat flaps are lifted at the top of the cone and sutured together to form the new nipple. Results: Thirty patients (mean age, 49 years; range, 43 to 60 years) underwent immediate nipple reconstruction between May of 1999 and December of 2001. A retrospective study of the 30 cases was conducted with a mean follow-up of 16.5 months (range, 2 to 31 months). Mean residual projection was 7.8 min after 1 year in 20 patients and 6.8 mm after 2 years in eight patients. Patient satisfaction with nipple projection was studied by means of a questionnaire. Seventy percent of patients considered the result very good, 23.3 percent considered it good, 6.6 percent considered it medium, and none considered it poor. Conclusions: On a psychological level, immediate nipple reconstruction seems to help assimilation of the reconstructed breast in the body image and leads to considerable patient satisfaction. Nipple reconstruction should no longer be considered as a secondary complement to immediate breast reconstruction. From the patient's viewpoint, the nipple appears to be an essential component of breast reconstruction.