Complete Avulsion of the Nipple-Areolar Complex Treated by One-Stage Reconstruction Using a Graft In Situ

Case Report

Austin J Clin Case Rep. 2022; 9(3): 1248.

Complete Avulsion of the Nipple-Areolar Complex Treated by One-Stage Reconstruction Using a Graft In Situ

Wu Y-H¹, Tan Q-W², Lu S³, Zhang W-F³, Lv Q³ and Chen J¹*

¹Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, China

²Department of Breast Surgery, Clinical Research Center for breast, West China Hospital, Sichuan University, Chengdu, China

³Department of Thyroid and Breast Surgery, Qiandongnan People’s Hospital, Guizhou, China

*Corresponding author: Jie Chen, Department of Breast Surgery, West China Hospital, Sichuan University, Guoxue Street 37#, Chengdu 610041, China

Received: February 28, 2022; Accepted: March 19, 2022; Published: March 26, 2022

Abstract

Background: Cases of complete avulsion of the Nipple-Areolar Complex (NAC) due to trauma are rare. The avulsed NAC can be replanted in situ if the vessels and nerves were anastomosed appropriately. However, this type of surgery is more complex, and requires longer operation times and the surgeon with training and experience of anastomosis of small vessels. We are looking for a more simple and effective method, which can be widely used.

Case Presentation: We reported a 19-year old girl whose left NAC had been completely avulsed by accident. We used a simple one-stage reconstruction surgery to modify the avulsed NAC as a tissue graft in situ. After 24 months, the reconstructed left nipple showed a similar appearance to the right. In addition, the patient showed high satisfaction with her breast appearance.

Discussion: Tissue graft in situ might be a simple, safe and reliable surgical procedure for completely NAC post-avulsion transplantation.

Keywords: Nipple reconstruction; Nipple-areolar complex avulsion; Tissue graft in situ

Introduction

Complete avulsion of the Nipple-Areolar Complex (NAC) due to trauma is a rare event. It has been reported that, the avulsed NAC can be replanted successfully in situ if the vessels and nerves were anastomosed appropriately [1]. However, this type of surgery is more complex, and requires longer operation times and the surgeon with training and experience of anastomosis of small vessels. In this case, we reported a sample one-stage reconstruction for women with complete NAC avulsion without vascular anastomosis.

Case Presentation

A 19 years old female patient fell from the bunk bed while sleeping, and hurt her left nipple. She admitted to our hospital 5 hours later. By physical examination, we found her left nipple was nearly completely avulsed, which only around 1/4 skin tissue was connected with the skin around the breast (Figure 1a and 1b). We removed all necrotic tissue and subcutaneous fat under the nipple-areolar complex (Figure 1c and 1d). There was a rough surface and a nearly 10 × 5 mm epidermis defect at 6 o’clock of the breast skin. Furthermore, the avulsed NAC began to show the signs of ischemia, which including dark colour, low skin temperature and no active bleeding in the wound. After debridement and sterilisation, we also found that there were no suitable blood vessels or nerves for anastomosis.