Background  

This article provides an algorithm for achieving an aesthetically pleasing nipple–areola complex in cases of skin-sparing mastectomy and immediate reconstruction

Methods  

If the contralateral nipple was big enough and the nipple-sharing technique could be used in the future for reconstruction, we left a round skin paddle at the time of the skin-sparing mastectomy and immediate flap reconstruction. The diameter of the round skin paddle was approximately the same as the contralateral areola. For nipple reconstruction we placed the graft from the contralateral nipple in the middle of the aforementioned skin paddle. If the contralateral nipple was not sufficiently large for use as a donor, then the C-V flap was used for nipple reconstruction. In these cases we deliberately left an oval skin paddle when the skin-sparing mastectomy and immediate flap reconstruction were performed. The short diameter of the oval skin paddle was approximately the same as the diameter of the contralateral areola. The position and the height of the C-V flap were marked in order to transform the oval skin paddle to a round one when the donor site of the C-V flap was closed.

Results  

Following this algorithm an optical illusion of a nipple–areola complex that is similar to the contralateral normal one is created.

Conclusion  

From our experience this algorithm can help create an aesthetically pleasing nipple–areola complex and also provides a ready pattern to our tattoing experts for the dermatography of the nipple–areola complex.