Reconstruction of the nipple-areolar complex after radical mastectomy

Reconstruction of the nipple areolar complex should be done as a second stage procedure about three months after volume replacement. Symmetry in position, size, and color is of utmost importance for the overall aspect of a breast reconstruction. One piece full thickness grafts from the opposite areola and nipple give the best results. When the remaining areola is too small to provide a full thickness graft, shaving of its surface may be used but often leads to later depigmentation. In these cases inguinal or perineal full thickness skin grafts seem preferable. Projection of the nipple remains a difficult goal. Experience of the authors with 74 nipple areolar reconstructions is discussed.