Reconstruction of the Nipple-Areolar Complex

Question 1

Nonsurgical options are also available and can achieve satisfactory reconstitution of the NAC.

Answer 1

T

Question 2

segment of the
the contralateral natural nipple is harvested and transferred to the reconstructed breast as a composite graft called nipple share technique

Answer 2

T

Question 3

This technique is most effective
in patients with a large contralateral nipple where projection exceeds
10 mm

Answer 3

F This technique is most effective
in patients with a large contralateral nipple where projection exceeds
5 to 6 mm

Question 4

composite nipple grafting cannot
provide sensation and erectile function in the reconstructed nipple

Answer 4

F composite nipple grafting can
provide sensation and erectile function in the reconstructed nipple
in some cases.

Question 5

The risk of reduced sensation and impaired
erectile function at the donor site has limited the popularity of nipple sharing

Answer 5

T

Question 6

In an effort to avoid contralateral surgery, banking of
the affected nipple at the time of mastectomy has been proposed

Answer 6

T

Question 7

Drawback of cryopreservation of the nipple

Answer 7

cryopreservation of the nipple results in tissue damage and
loss of pigmentation that adversely affects aesthetic outcomes.

Question 8

Grafting remains a favorable option in patients who have thin skin
and subcutaneous tissues following alloplastic breast reconstruction.

Answer 8

T

Question 9

donor sites for nipple grafts including
labia, earlobe, toe pulp, and skin from the postauricular area, medial
thigh, and axilla

Answer 9

T

Question 10

The popularity of grafting has waned with
the advent of a multitude of local flap techniques that eliminate the
need for a secondary donor site and the risk of associated morbidity

Answer 10

T

Question 11

classification
system of nipple reconstruction of local flap

Answer 11

(1) centrally based flaps,
(2) subdermal pedicle local flaps with single pedicle,
(3) subdermal pedicle local flaps with double pedicle.

Question 12

The commonest techniques currently in use (skate flap, star flap, and C-V flap)
consist of two larger lateral flaps that are approximated to create the
circumference of the nipple and a smaller central flap that forms the
tip of the nipple

Answer 12

T

Question 13

long-term loss ofnipple projection reported to be between
10% and 50%

Answer 13

F long-term loss ofnipple projection reported to be between
40% and 70%

Question 14

reconstructed nipple loses
projection in the first year

Answer 14

F Studies suggest that the reconstructed nipple loses
projection in the first 2 years postoperatively, after which time the
height remains relatively stable

Question 15

double wide-based flaps that preserve rich subdermal vascularity may limit postoperative contracture.

Answer 15

T

Question 16

Incorporation of subcutaneous fat or de-epithelialized dermis into the lateral flaps may
increase the bulk of the reconstructed nipple

Answer 16

T

Question 17

Centrally based
flaps such as the quadrapod flap are subject to the highest degree of
postoperative retraction.

Answer 17

T

Question 18

surgeons should aim to create a nipple that is at
least 50% larger than required

Answer 18

T

Question 19

Augmentation techniques have been described in an effort to
improve nipple projection

Answer 19

T

Question 20

auricular cartilage is better utilized than costal cartilage in breast reconstruction with nipple

Answer 20

F costal cartilage was identified as a more accessible autologous material because it could be harvested and banked at
the time of the initial breast reconstruction and eliminated the need
for additional donor sites

Question 21

Using fat rather than cartilage is safer for nipple reconstruction

Answer 21

T

Question 22

The soft consistency of fat grafts may reduce the risk of flap
necrosis,

Answer 22

T

Question 23

Acellular dermal matrix and prefabricated collagen tubes can also be used to support local flap reconstruction

Answer 23

T

Question 24

Several
alloplastic augmentation techniques have also been described including calcium hydroxylapatite, silicone, hyaluronic acid, and polytetrafluoroethylene.

Answer 24

T

Question 25

The contralateral areola is the ideal source of
donor skin and commonly used

Answer 25

F but is rarely used unless the patient is undergoing a concomitant balancing breast reduction

Question 26

Grafting of the areola usually occurs at the same time
as nipple reconstruction. An area ofdeepithelialization can be incorporated into the nipple flap design to accommodate the skin graft

Answer 26

t

Question 27

Fading
ofpigmented skin grafts commonly occurs over time

Answer 27

T

Question 28

Intradermal tattooing has become a popular method of areola reconstruction.

Answer 28

T

Question 29

Tattoo pigments, consisting of iron and titanium
oxides, are deposited into the dermis using a dermabrasion technique.

Answer 29

T

Question 30

The initial tattoo should
be darker than required in anticipation of this

Answer 30

T

Question 31

Deposition of pigment at the correct dermal level is also important why?

Answer 31

because if it is too superficial, it will slough off in the early postoperative period, but if it is too deep, it will be degraded by macrophage activity

Question 32

Tattooing is
generally performed 4 weeks after reconstruction of the nipple

Answer 32

F Tattooing is
generally performed 6 to 8 weeks after reconstruction of the nipple

Question 33

some surgeons advocate
tattooing of the areola prior to nipple reconstruction

Answer 33

T

Question 34

The tattoo simulates the nipple projection through color contrasts and also mimics the texture of a natural
areola.

Answer 34

T

Question 35

The commonest complications are loss of projection and fading of
pigmentation over time.

Answer 35

T