[Reconstruction of the breast areola complex. Comparison of different techniques]

Different methods have been used in our department for nipple-areola reconstruction. This study was undertaken in order to find out which method of reconstruction shows optimal long-term results. Between 1983 and 1999, breast reconstruction was performed in 204 patients and different methods were used for nipple-areola reconstruction. 91 patients could be examined. For areola reconstruction full-thickness skin grafts from the groin were used as well as skin grafts from the contralateral areola, vaginal mucosal grafts, and tattoos. For nipple reconstruction we used nipple sharing, labium grafts, local flaps, and a tattoo. Areola reconstruction with full-thickness skin grafts from the groin was performed in 45 patients, in 16 patients a graft from the contralateral areola was used and in 19 patients the technique of intradermal tattoo was applied. One patient had a vaginal mucosal graft, in another patient the nipple areola complex was transplanted to the groin after mastectomy for later reconstruction. Nipple projection was measured and the colour of the reconstructed areola was compared to the other side. Concerning the match of colour, best results were achieved with grafting from the contralateral areola, followed by areola tattoo and skin grafts from the groin. The vaginal mucosal graft was too dark. The transplanted original nipple-areola complex maintained its colour. Nipple projection between 3 and 4 mm was achieved by nipple sharing and local flaps. With grafts from the labium, a projection from 1 to 2 mm was achieved. Thus, best results were achieved by nipple sharing, local flaps for nipple reconstruction and areola skin grafts from the contralateral side. Vaginal mucosal grafts and grafts from the labium are not recommended.