Immediate nipple reconstruction utilizing the DIEP flap in areola‐sparing mastectomy

Abstract

The surgical treatment of breast cancer has dramatically evolved over the past decade toward an approach combining oncologic safety with aesthetic outcomes. The skin-sparing mastectomy initiated this paradigm shift amongst breast surgeons and can be oncologically safe, in some cases sparing both the areola and the nipple. In accordance with the emphasis on aesthetics, some general surgeons have adopted new methods of resecting only the nipple, sparing the areola in select patients. The superior aesthetic results, durability, and decreased donor site morbidity of perforator flaps have brought autologous reconstruction back to the forefront of breast reconstruction with the deep inferior epigastric artery perforator (DIEP) flap as the gold standard. We describe a technique utilizing the DIEP flap skin paddle for immediate nipple reconstruction at the time of mastectomy and reconstruction, eliminating the need for delayed reconstruction and limiting donor site morbidity by concealing the donor site below the mastectomy skin flaps. In the six cases described performed between 2010 and 2012 (mean with 53 years; range 46-59 years), there have been no complications to the flap or the nipple postoperatively, nor has there been a need for further nipple revisions for 6 months. The nipple position relative to the flap breast mound has remained unchanged for up to 6 months. The immediate nipple reconstruction does not significantly lengthen operative time, requiring approximately 30 additional operative minutes per nipple. Immediate nipple reconstruction utilizing the DIEP flap can be a cost-effective and feasible technique for recreating a natural-appearing and aesthetic nipple in select patients.

Immediate nipple reconstruction with thoracodorsal artery perforator flap in breast reconstruction by latissimus dorsi myocutaneous flap in patients with Poland's syndrome

“…Currently, immediate nipple reconstruction is also performed during the breast reconstruction . Craig et al described the immediate nipple reconstruction with a skate or C‐V flap on a free deep inferior epigastric artery perforator flap. Williams et al performed the breast reconstruction with a free transverse rectus abdominis myocutaneous flap.…”

Effect of perioperative transfusion of old red blood cells on postoperative complications after free muscle sparing transverse rectus abdominis myocutaneous flap surgery for breast reconstruction

“…[3][4][5] Various flaps including the transverse rectus abdominis myocutaneous (TRAM) flap, deep inferior epigastric perforators (DIEP) flap, superior gluteal artery perforator flap, and superficial inferior epigastric artery flap have been used for breast reconstruction after mastectomy. [6][7][8][9] Among the flaps, microsurgical breast reconstruction with the DIEP and TRAM flaps has been commonly and safely used in even patients with comorbidity because they are associated with low postoperative complication rates, excellent aesthetic outcome, and high patient satisfaction. 10 Especially, the muscle-sparing TRAM free flap has less morbidity on the donor site than the classic TRAM flap and less harvesting time than the DIEP flap.…”

Internal mammary perforator vessels as recipient site for microsurgical breast reconstruction: A comparative histomorphometric analysis and incidence of degenerative vascular changes

“…In recent years, the internal mammary perforator (IMP) vessels are becoming a reliable alternative . Main advantages are sparing the IM vessels and reducing operative time due to limited dissection …”

“…[1][2][3][4][5][6][7][8][9] Among the main options, the internal mammary (IM) vessels have gained popularity and have been recommended as the option of choice. [10][11][12][13][14][15][16] The adequate caliber is frequently observed, and the deleterious radiotherapy effects are often absent. However, its use is not free of morbidity, and thoracic contour deformities, risk of pneumothorax, and impairment for future coronary bypass have been mentioned.…”

“…[17][18][19][20][21][22][23][24][25][26][27] Main advantages are sparing the IM vessels and reducing operative time due to limited dissection. [10][11][12][13][14][15][16] Despite the technical refinements of microvascular breast reconstruction procedures, some anastomoses still fail. [4][5][6]9 The etiology is multifactorial and includes patient selection, surgical technique, and postoperative hemodynamic monitoring.…”