Nipple Areola Complex Reconstruction: An 8-Year Experience With Modified Technique and Systematic Review.

Background: Nipple areola complex reconstruction is often the last procedure offered to patients undergoing breast reconstruction. Although comparatively minor, this final step creates the focal point of the breast while signifying the end of an often long and difficult journey for patient and surgeon. The literature demonstrates that nipple areolar complex (NAC) reconstruction conveys a positive impact on overall body image while defining the final aesthetic outcome. This paper presents a novel technique for NAC reconstruction developed at a UK tertiary referral center. It is supported by a systematic review of the current literature.

Methods: Between 2014 and 2022, a new technique was used to reconstruct the NAC using a modification of the C-V flap with a full-thickness skin graft (FTSG) and later nipple tattoo, if required. Patients were followed up in clinic noting complications, satisfaction, and need for revision surgery. The study was completed by conducting a systematic review of the literature assessing areolar reconstruction with skin grafts, according to PRISMA guidelines.

Discussion: This technique provides excellent results in terms of patient satisfaction and objective outcomes (complication rate, need for revision procedures, and loss of projection requiring further surgery). This literature review reflects alternative techniques and highlights the advantages of using a modified C-V flap with FTSG, in terms of morbidity and patient satisfaction.

Conclusions: NAC reconstruction is the "cherry on top" at the end of the breast reconstructive journey. This paper advocates a technique that is reproducible, with minimal complications, excellent outcomes, and long-standing results.