Nipple areola reconstruction.

Creation of the nipple areolar complex often represents the final hurdle in a long and arduous reconstructive process for women with breast cancer. It is as important as any aspect of the reconstruction, and closes the chapter for both patient and surgeon. In essence, it transforms the reconstructed mound into a breast. To facilitate the process of nipple-areola reconstruction (NAR) and subsequently complete the reconstructed breast, the procedure needs to be as convenient, painless and reliable as possible. The reconstructed nipple has both physical and psychological ramifications, and of primary importance is long-term patient satisfaction. Although nutritional and erotic capabilities cannot be reproduced, the essential characteristics of successful nipple reconstruction are the creation of symmetry with the opposite breast (size, color, texture, location) and adequately maintained projection. There are numerous techniques available for nipple reconstruction, which involve some variant of composite grafting or a local tissue flap. Areolar reconstruction ranges from simple tattooing to more complex grafting techniques. This chapter will discuss some of the more commonly used NAR techniques.