[Comparison of the nipple projection after reconstruction with three different methods]

The creation of the nipple-areola complex represents the final stage in the surgical treatment of breast cancer patients. Preservation of the nipple projection is important and difficult to achieve. A huge number of different methods for nipple reconstruction have been well described, but some of them fail secondary to scar contraction with loss of projection. Furthermore, there are only few studies investigating the degree of shrinkage over time in nipple projection. Aim of this study was to determine the long-term projection of the reconstructed nipple. We compared three different methods that have been used in our department for nipple-reconstruction. Between May 1994 and December 2001, reconstruction of the breast mound was performed in 146 patients. 86 patients who underwent a unilateral reconstruction of the nipple have been examined. The nipple reconstructions were performed by using either a modified skate-flap (n = 29), a quadrapod-flap (n = 37) or by nipple sharing (n = 20). Nipple projection was measured at least six months after the reconstruction. Patients were followed an average of 10.9 +/- 3.62 months. 38 patients had tissue expansion and implantation for breast mound reconstruction. 29 patients had autologous breast mound reconstruction and 19 patients were treated by a combination of both. The mean projection was 3.45 mm (+/- 1.23) in the nipple sharing group, 6.03 mm (+/- 1.86) in the quadrapod-flap group and 9,24 mm (+/- 2.45) in the skate-flap group. The mean decrease in projection for the nipple sharing was 27.6 +/- 18.2 % while the skate flap lost 45.0 +/- 11.1 % and the quadrapod flap 49.9 +/- 11.56 %. Comparison between the three groups using a Student-t test showed a statistical significance between the nipple sharing and the two other groups (p < 0.001), while there was no significance between the local flap groups (p = 0.082). The best long-term nipple projection was obtained by the nipple sharing, but the indication therefore is rare whereas local flaps are used more often. We conclude that although both methods are effective, the skate flap allows the surgeon to overbuild the nipple and achieve a higher projection. In addition, the results also indicated that nipple projection on the breast mound reconstructed with autologous tissue achieved a better long-term outcome.