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Double Donut Split Nipple and Areolar Graft Reconstruction
Evan Westrick, MD
Bradon Wilhelmi, MD
University of Louisville
2022-01-15
Presenter: Evan Westrick
Affidavit:
Bradon Wilhelmi
Director Name: Bradon Wilhelmi
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Background: Preservation or restoration of the nipple areolar complex (NAC) has been repeatedly shown to improve the cosmetic outcomes and quality of life (QoL) in post mastectomy patients. Despite advances in breast conserving therapy (BCT) as well as nipple sparing mastectomy (NSM), many patients undergo bilateral skin sparing mastectomy with reconstruction. Particularly challenging cases within this population are those with grade 3 ptosis, macromastia and high BMI >30. Multiple techniques of NAC reconstruction have been described but each technique has its pitfalls. In this study we evaluated the outcomes of patients with the Double Donut split nipple and areolar reconstruction (DDR).
Methods: A single center prospective study was performed for patients undergoing immediate post-mastectomy reconstruction with the DDR technique. Demographics including Age, BMI, ptosis grade and smoking status were recorded. Post reconstruction endpoints of areolar graft failure, nipple composite graft failure, patient satisfaction with NAC appearance and delay in administration of adjuvant therapy were recorded.
Results: 20 patients and 40 breasts underwent immediate reconstruction with the DDR technique. 1 of 40 (2.5%) nipple composite grafts failed and 1 of 40 (2.5%) of areolar grafts experienced partial graft loss. All patients were able to proceed with adjuvant therapy if indicated without delay. All patients reported satisfaction with their results.
Conclusions: The DDR technique can be successfully applied to achieve cosmetically satisfactory results in the post mastectomy reconstruction patient. This technique has shown reliable outcomes with respect to graft success and patient satisfaction with their NAC reconstruction.
