NIPPLE-AREOLA RECONSTRUCTION: IMPROVEMENT OF “FOUR-SQUARE” TECHNIQUE

Douglas M. Pires, Jose S. Filho, Carolina L. Figueiredo, Carolina N. Valadares, Mariana S. Nascimento, Ana Carolina G. Mendonça, Raffaela L. Andrade, Izabel A. C. Andrade

Institution: Santa Casa de Belo Horizonte

Introduction: Over the last decades, the approach of breast cancer surgery has changed. The oncological surgery is still priority but cosmetic outcome associated with it is also important because of women´s self-esteem. Nowadays, Oncoplastic techniques for breast reconstruction are becoming the new standard of care for surgeons. A relevant part of oncoplastic surgery is the nipple-areola complex reconstruction. This procedure improves satisfaction of patients because it adds realism and symmetry to the new breast. Different procedures have been described for nipple-areola reconstruction, but most of them are not able to maintain the aesthetic result permanently because of a excessive loss in nipple projection. Approximately fifty percent of the volume of the new nipple is lost, even when different techniques are used. Objective: to describe a new technique without the loss of nipple projection. Methods: The “square-flap” is one of the most popular techniques for papillary reconstruction, easy to perform and well-known for breast surgeons. We improved the “four-square” technique with a simple modification, in order to achieve long-term aesthetic result with a better projection of the nipple. We used a de-epithelialization of all wing of the square to fullfil the new papilla and cover this with free skin graft. Results: Tests are being conducted to prove the efficacy of this new approach in patients in two hospitals, Santa Casa de Belo Horizonte (Minas Gerais state, Brazil) and Santa Casa de Ilhéus (Bahia state, Brazil), both of them performed by breast surgeons. The outcomes are going to be published later on, but so far the patients and doctors are satisfied with the results. No complications have been described until this moment. Conclusions: Oncoplastic surgery has improved women´s well-being after mastectomy. New approaches emerge every day to upgrade existing techniques, as we described above. Key-words: nipple, reconstruction.