[Reconstruction of the nipple-areolar complex: long-term results]

The aim of this study was the long-term evaluation of different techniques concerning the reconstruction of a nipple-areola complex.

We included 135 women who had undergone nipple-areola reconstruction between 1983 and 2004. A clinical examination was performed after a mean delay of 5 years and 3 month (1-24). All of the patients were asked to evaluate their level of satisfaction based on a grading scale displaying four scores. The most important parameters (texture, shape, size, color, position, nipple projection) and the complication-rate were investigated. The different techniques were compared with each other to determine the one giving the best results.

Eighty-nine percent of the patients were satisfied or even very satisfied with their nipple-areolar reconstruction. Eleven percent were disappointed or very disappointed. The factors patients disliked the most were, in descending order, dys-chromia (45%), hypo-sensibility (37%) and lack of projection (36%). When the opposite areola is used as donor site, results seem to be more satisfactory than using a full-thickness skin graft from the upper inner thigh (P=0.054). Concerning the rebuilding of the nipple, the graft from the opposite nipple leads to a mean projection of 3.4 mm where the local flap leads to 2.4 mm and the earlobe composite graft to 1.5 mm (P<0.001).

Removing a part of contralateral nipple and areola when possible, reveals itself to be the most effective technique showing the most stable long-term results.