A Simple and Inexpensive Postoperative Shield Dressing in Simultaneous Reconstruction of Nipple–Areola Complex

Nipple–areola complex reconstruction (NAR) represents the final stage in the long process of postmastectomy reconstruction. The newly reconstructed nipple is extremely sensitive to mechanical forces, which can cause flap necrosis, cartilage dislocation when used, and, therefore, reduce final projection.

Different methods have been reported in the literature to protect the reconstructed site and stabilize the skin graft.^1,2 Most of the described dressing regimens can be expensive, time-consuming, and difficult to place for the patient. We present an extremely simple and inexpensive dressing that is easy to apply and can be manufactured based on materials available everywhere.

Between January and December 2014, 20 patients underwent NAR by the same plastic surgeon. In all cases, nipple reconstruction was performed after arrow flap technique and cartilage graft interposition (rolled conchal auricular cartilage or costal graft if previous autologous breast reconstruction was done with free flaps).^3,4 Overcorrection of the nipple height (20% higher than the contralateral) was performed. Simultaneously, the areola was reconstructed with local skin graft,⁵ which was fixed with nylon 4/0 simple stitches, leaving long sutures. The graft was covered with tulle and gauzes with a central window for the nipple.

The top of a bottle of saline was cut as a shield with a central hole. Then, the protective plastic was applied over the reconstructed areola, with the convexity in contact with the gauzes, and the long ends of the sutures were tied over the shield to secure it and help fixate the graft (Fig. 1). Nipple viability could be evaluated postoperatively through the window. On postoperative day 5, the tie-over was taken down, wound dressing was changed, and the shield was superimposed with the convexity upward, easily secured in place with surgical tape, just to protect the nipple (Fig. 2). We allow the patient to wear a bra just after the surgical procedure, and we encourage the use of the protective device for 1 month. If necessary, patients had tattooing 3 months after the procedure.

Fig. 1.

The nipple–areola complex is shielded by the top of a saline 500-ml bottle with central hole and the convexity in contact with the gauzes.

Fig. 2.

After graft stabilization, the shield was superimposed with the convexity upward, secured in place with surgical tape, just to protect the nipple.

All the patients were followed up at least 2 years. No major complications as flap or graft loss were observed. Flattening was lower than 30% in all the cases (mean = 2 mm).

In our series, this dressing technique has proved useful for compressing the graft, avoiding fluids accumulation, and preventing trauma to the nipple. The availability of universally present elements in any operating room makes it possible to use this simple device, without cost, and saving time.