Nipple-areolar complex (NAC) reconstruction following curative mastectomy is traditionally performed as a second-stage procedure several months after initial breast reconstruction. The recent literature has documented the increasing popularity of immediate nipple reconstruction carried out simultaneously during autologous reconstruction.

All patients who underwent a skin-sparing mastectomy with immediate latissimus dorsi flap breast and NAC reconstruction as a single-stage procedure from 2007 to 2015 were included.

Patient demographics, oncologic details, and surgical outcomes were recorded. The BREAST-Q questionnaire was administered to patients to assess the impact and effectiveness of this reconstructive strategy.

During the study period, 34 breast and NAC reconstructions in 29 patients were performed at Cork University Hospital. Most of our patient cohort were non-smokers (93.1%) and did not receive adjuvant radiotherapy.

Postoperative complications

Postoperative complications were infrequent, with no cases of partial necrosis or complete loss of the nipple. The response rate to the BREAST-Q was 62% (n=18). Patients reported high levels of satisfaction with the reconstructed breast (62±4), nipple reconstruction (61±4.8), overall outcome (74.3±5), and psychosocial well-being (77.7±3.2).

Skin-sparing mastectomy with immediate nipple reconstruction during autologous latissimus dorsi reconstruction was demonstrated to be a safe and aesthetically reliable procedure in our cohort, yielding high levels of psychological and physical well-being. A single-stage procedure promotes psychosocial well-being involving issues that are intrinsically linked to breast cancer surgery.

The authors acknowledge some limitations of this study. The time of the surgical procedure was not matched to the time of BREAST-Q completion, which represents a source of potential bias. Nipple projection and maintenance of nipple projection over time were not objectively assessed given the retrospective nature of the study.

Loss of nipple projection is a risk with all reconstructions and has been reported to be as high as 40% in the literature (for nipple reconstruction using the C-V flap technique). However, loss of nipple projection has been shown to have a minimal impact on overall patient satisfaction.

Furthermore, our study reflects an unmatched cohort. No study has yet been conducted of delayed nipple reconstruction using the BREAST-Q tool. Despite this, there is a growing body of literature describing the benefits of immediate NAC over traditional 2-stage reconstruction, from both aesthetic and psychological perspectives.

In conclusion, SSM with immediate nipple reconstruction during autologous LD reconstruction was demonstrated to be a safe and aesthetically reliable procedure in our cohort, yielding high levels of psychological and physical well-being.

Reconstructions may be completed sooner and with fewer procedures. A single-stage procedure promotes psychosocial well-being involving issues that are intrinsically linked to breast cancer surgery.