Nipple-Areolar Complex Reconstruction

Excerpt

Breast cancer is the most common cancer diagnosis in women, with an annual incidence of approximately 1 in 10. Breast cancer treatment frequently involves surgical oncologic resection and reconstruction if breast reconstruction is desired. Reconstructive breast surgery is frequently staged to recreate a naturally-appearing breast and correct asymmetries. Non–nipple-sparing mastectomy, malignant involvement of the nipple-areolar complex (NAC), and NAC complications following prior reconstruction may absent the NAC from the reconstructed breast. If NAC reconstruction is desired by the patient, this procedure is usually the final stage of breast reconstruction. The ideal NAC reconstruction recreates both the nipple and areola and achieves symmetry in position, size, shape, texture, pigmentation, and projection to the contralateral NAC.

NAC reconstruction can be accomplished via various methods. Studies have demonstrated a correlation between patient satisfaction with breast reconstruction and the presence of a nipple and areola, helping combat the psychological consequences of a breast cancer diagnosis. Thus, NAC reconstruction plays an important role in accepting a reconstructed breast into a self-image. However, not all women desire NAC reconstruction. The provider must discuss NAC reconstruction openly and not predicate the completion of breast reconstruction on the recreation of the NAC.

This activity reviews the indications, contraindications, procedural techniques, and complications of NAC reconstruction following breast cancer surgery. Similar techniques may be utilized in the surgical treatment of athelia and burn-related disfiguration. The activity also outlines the role of the interprofessional team in caring for patients who elect to undergo NAC reconstruction following surgery for breast cancer.