Adjunct Procedures in Breast Reconstruction

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Breast reconstruction is often a multi-step process that can require several interventions to achieve the final desired outcome. After the initial reconstruction, there are additional procedures that help refine the breast’s appearance, including lipofilling, breast symmetry corrections and nipple and areola reconstruction. These adjunct procedures play a key role in enhancing the aesthetic result and overall satisfaction of the patient. 

Breast symmetry, or “symmetrization,” is often needed to match the appearance of the contralateral breast to the reconstructed one. This is typically done after the reconstructed breast has settled into its final shape, which could take 3-4 months post-reconstruction. Techniques to achieve symmetry may involve a breast reduction, lift (mastopexy), or augmentation on the unaffected breast, depending on the difference in size or sagging between the two. These procedures are commonly combined with nipple and areola reconstruction. 

Patients who have undergone lumpectomy as part of breast-conserving therapy may experience aesthetic deformities, which can be addressed with additional procedures. 

The primary method to correct such deformities is autologous fat grafting, or lipofilling, which involves harvesting fat from other areas of the body and injecting it into the breast to fill in contour irregularities. In more severe cases, plastic surgery techniques such as breast reduction or lifting may be required to restore a natural breast shape. Occasionally, the severity of the deformities might necessitate a complete mastectomy followed by reconstruction with a tissue flap. 

Nipple and areola reconstruction is typically the last step of the breast reconstruction process. It is performed after the reconstructed breast has achieved the desired shape and volume. Techniques for reconstructing the areola include using a skin graft from the inguinal crease, which offers texture but may not perfectly match the color of the other areola. Alternatively, a surgical tattoo, known as dermopigmentation, can provide better color results, though it lacks texture. Often, combining both techniques leads to optimal outcomes. For nipple reconstruction, options include using a graft from the remaining nipple or creating a new nipple using local skin flaps, particularly in autologous reconstruction cases. A 3D tattoo may also be used to recreate the appearance of a nipple and areola without surgery, offering a natural look through optical illusions of depth and texture.