Goals/Purpose:
The goal of this study was to analyze the aesthetic contribution of the nipple-areola complex (NAC) to the postoperative result of implant-based breast reconstruction by comparing reconstructed breasts with and without the NAC.
Methods/Technique:
Ten consecutive patients who underwent implant-based breast reconstruction by a single surgeon were studied, five following nipple-sparing mastectomy (NSM) and five following skin-sparing mastectomy (SSM). A graphic editing program was used to remove the NAC from postoperative NSM photos (NSM w/o NAC) and to add the NAC to postoperative SSM photos (SSM w/ NAC). Two separate plates of photographs were created for each patient: (1)actual preoperative and actual postoperative photos and (2)actual preoperative and photoshopped postoperative photos (Plates 1-2). Twenty-nine reviewers (plastic surgery attendings, residents, and nurses) were asked to evaluate the photographic plates by responding a questionnaire (Figure 1). A five-point scale was used to evaluate factors contributing to the aesthetic result. Comparisons were made in between the actual and photoshopped scores for each type of breast reconstruction. Comparisons were also made between NSM scores and SSM scores. The paired ratings of the photos were evaluated using Wilcoxon signed rank tests.
Results/Complications:
The overall reviewer scores favored reconstructions with preservation of the NAC, with statistical significance (p< 0.05) in the vast majority of comparisons (Tables 1-3). Visual presence of the NAC (Table 2a-b: SSM vs. SSM w/ NAC and NSM vs. NSM w/o NAC) and anatomic presence of the NAC (Table 3a-b: SSM vs. NSM w/o NAC and SSM w/ NAC vs. NSM) were analyzed separately and both had a positive impact on the aesthetic outcome.
Conclusion:
The presence of the NAC has a significant positive contribution to the aesthetic result of implant based breast reconstruction. Our analysis distinguishes the independent value of the visual and anatomic components of the NAC in breast reconstruction.
