ABSTRACT
Introduction The final stage in breast reconstruction is creation of the nipple-areolar complex
(NAC), which carries aesthetic and psychological importance to patients with con genital and acquired breast absence, whether from trauma, burns, or after mastec tomy for cancer treatment. Nipple-areola reconstruction (NAR) began 40 years ago with the initial creation of both the nipple and areola from distant grafts. Subse quently, this approach transformed into a combination of local flaps for nipple re construction and distant grafts for the areola. Many of the earlier methods for nipple reconstruction are no longer used and have been relegated to historical significance including nipple banking due to spread of cancerous cells, nipple sharing due to insult on the contralateral nipple and free composite grafts of tissue from distant sites due to donor site morbidity. The current trend is the use of local dermal flaps alone with tattooing. These methods have proven to be cost-effective and carry low morbidity. These evolving techniques and modifications of NAR are based on sim plicity and reliability; however, all are hampered to some extent by loss of long-term nipple projection. The goal of reconstruction is to create an aesthetically pleasing nipple areola complex with maintenance of nipple projection, symmetry and color. Although there have been numerous articles published regarding patient satisfac tion, overall nipple projection and optimal color match of different methods, no one technique has proven to be superior.
