Immediate two-stage nipple reconstruction with a local mastectomy flap following secondary autologous breast reconstruction

SummaryBecause of the inevitable postoperative shrinkage, an initial hypercorrection is emphasized in nipple reconstruction with a random skin flap. However, the breast shape will be damaged if an excessively large flap is raised on the surface of the breast mound. A technique for immediate two-stage nipple reconstruction with a local mastectomy flap during the secondary breast reconstruction was reported in this study. From February 2011 to March 2014, 33 patients underwent breast reconstruction and immediate two-stage nipple reconstructions. A bipedicle deep inferior epigastric artery perforator (DIEP) flap was raised and folded upward to form the breast. Simultaneously, a deepithelialized lower mastectomy flap with a distant skin paddle was elevated and pulled throughout the reconstructed breast. The skin paddle was carefully sutured to the position of the future nipple. After 3 weeks, the pedicle of the mastectomy flap was divided, and the paddle was modeled to form the new nipple. Both the new nipple and the DIEP flaps survived postoperatively. The average projection of the reconstructed nipple was 15.4 ± 2.7 mm immediately after the surgery, which gradually decreased to 8.2 ± 1.1 mm during the first year of follow-up. A total of 29 patients ranked the aesthetic appearance of the reconstructed nipple and breast as “very good” or “good.” On the basis of our breast-shaping techniques, the proposed immediate two-stage nipple reconstruction approach is able to maintain long-term residual projection and results in considerable patient satisfaction.Level of evidenceIV.