الفهرس 
EMBRYOLOGY AND BREAST DEVELOPMENTOnly 14 pages are availabe for public view
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Abstract
Reconstruction of the nipple-areola complex (NAC) is considered the last hurdle to complete breast reconstruction and to restore the patient’s body image. Following mastectomy for breast cancer, NAC reconstruction is mostly the final aspect of breast reconstruction because prior creation of a symmetric breast mound is mandatory.
Other conditions requiring NAC reconstruction include congenital or developmental pathology (athelia, amastia), posttraumatic or burn deformities, and complications from breast surgery such as reduction mammaplasty.
The development of NAC reconstruction parallels the history of breast reconstruction. Continuous progress in the treatment of breast cancer, technical advances in reconstructive techniques and increasing public awareness of the possibilities of breast reconstruction have stimulated the development of new concepts in NAC reconstruction, and numerous techniques were created over the years, While some methods have been discredited to historical significance only, some other techniques have evolved to widely accepted concepts.
Ideal reconstruction of the NAC requires symmetry in position, size, shape, texture, and pigmentation and permanent projection. Generally, NAC reconstruction can be safely performed on an outpatient basis under local anaesthesia. In order to achieve successful NAC reconstruction, general guidelines must be adhered to independent of the chosen technique:
(1) NAC reconstruction is postponed till the final and stable setting of the reconstructed breast mound, optimally 3–4 months following breast reconstruction, although some authors have proposed primary NAC reconstruction at the time of breast reconstruction.
(2) In unilateral reconstruction, the contralateral NAC serves as a template. However, the position has to be adapted to residual breast asymmetries.
(3) In bilateral reconstruction, the NAC location is planned according to relative anatomical landmarks and aesthetic preferences of the patient.
(4) Loss of projection of the reconstructed nipple should always be anticipated due to contraction, and overcorrection of 25–50% of the desired result is advisory in NAC reconstruction with local flaps.
While reconstruction of areola usually does not pose difficulties, creation of a natural 3-dimensional nipple with lasting projection remains a challenge.
The variable consistency of this anatomical structure in relaxed or erect condition is yet unattainable.
Multiple procedures have been described, but none has been universally favoured. Currently, subdermal single and double-pedicled flap techniques for nipple reconstruction combined with skin grafting and tattoo for areola reconstruction are the first-choice. In order to avoid donor site morbidity, some authors refuse skin grafting and use only tattoo for the simulation of the areola.
Today’s techniques are able to provide a satisfactory imitation of the NAC with good symmetry and long-lasting results.
Different techniques are available, to suit the individual situation, and have to be selected according to local tissue requirements and the preferences of the patient and surgeon.
Future developments in NAC reconstruction could be directed towards reconstruction of a more functional nipple-like structure by tissue engineering techniques.