Yin-Yang NAC sharing: Full-thickness split graft from a single NAC for bilateral immediate reconstruction after skin-reducing mastectomy

Nipple-areola complex (NAC) reconstruction significantly contributes to postmastectomy body image and patient satisfaction. While nipple sharing has been described in delayed settings, its application in immediate reconstruction after skin-reducing mastectomy (SRM) is limited. We report the case of a 32-year-old BRCA1+ patient undergoing bilateral SRM with immediate implant-based reconstruction, in which a novel Yin-Yang nipple grafting technique was performed using the hypertrophic contralateral nipple. The donor nipple was harvested as a full-thickness non-vascularized graft, divided along a curved Yin-Yang fashion, and both halves were reshaped and grafted bilaterally to create two circular, natural-looking NACs. At the 6-month follow-up, the grafts showed complete take, satisfactory projection, and pigmentation. This report illustrates the feasibility and limitations of one-stage NAC reconstruction using a non-vascularized nipple graft technique in a selected patient undergoing SRM.