Dominique Erni

Nipple-Areola Complex Replantation After Mastectomy and Immediate Breast Reconstruction

Traditionally, the nipple-areolar complex (NAC) is resected during mastectomy. The NAC determinates aesthetic outcome after breast reconstruction, and a natural-looking NAC can barely be reconstructed with other tissues. The aim was to assess the oncological safety as well as morbidity and aesthetic outcome after replantation of the NAC. Retrospective analysis of 85 patients receiving 88 mastectomies and IBR was conducted. NAC (n = 29) or the nipple alone (n = 23) was replanted 7 days (median, range 2–10 days) after IBR in 49 patients. Malignant involvement of the subareolar tissue was found in eight cases (9.1%). In 69% and 26% of the cases, total or partial necrosis occurred if the entire NAC or only the nipple were replanted, respectively (P <0.01). Depigmentation was seen in 52%, and corrective surgery was done in 11 out of 52 NAC or nipple replantations. Local recurrence and isolated regional lymph node metastasis were observed in one single case each. It can be concluded that the replantation of the NAC in IBR is oncologically safe. However, the long-term aesthetic outcome of NAC replantation is not satisfying, which advocates replanting the nipple alone.