Nipple-areolar reconstruction: a different approach to skin graft fixation and dressing

Nipple-areolar reconstruction (NAR) is now an integral component of any type of breast reconstruction. This study presents a simple and reliable skin graft fixation and dressing technique used on 278 NARs in 221 patients from 1996 to 2000. Nipples and areolas were reconstructed with a modified skate flap and a full-thickness skin graft, respectively. Skin grafts were sutured and stented using Steri-Strips. A Tielle hydropolymer dressing with a central fenestration was used to cover the whole nipple-areolar complex. The nipple is dressed further with gauze and Microfoam tape. All nipples demonstrated 100% survival. There was one partial skin graft loss and 5% of the grafts had mild epidermolysis with eventual full reepithelialization. This dressing regime is simple and reliable in ensuring optimal skin graft take and nipple viability. It provides compression of the graft to prevent shearing and fluid accumulation, excellent absorbing capacity, a moist environment to promote wound healing, and maximal patient comfort.