Objectives: Since Leon Perel in 1967, ( he was a very innovative french surgeon , who promoted direct labial minora grafts in order to reconstruct the little areola missing after mastectomy for surgical cancer treatment, and became subject of hard criticism from his colleagues, because he dared to reconstruct the normal anatomy after breast cancer!), many techniques have been advocated for nipple and areolar complex reconstruction;
most authors focalize on local flaps or tattoo painting;
Introduction: My personal approach has been to use the pinky paralabial minora skin as a composite total depth skin graft for areolar reconstruction, and a third of the opposite nipple for nipple repair, as a composite graft;
When the opposite nipple is too small or not present, i have used a composite graft from the ear lobula;
The precise technic will be described in details;
The advantages of this technique is a good appearance of the areolar and nipple complex, with a nice elevation, good color match, and good time persistance over 20 years;
The drawbacks are a risk of failure of the grafts if badly taken or inserted, and a slight decoloration, depending mostly of the skin type and paleness of the donor site. Secondary tattoing may then be useful, but the areolar disk still gets the surelevation present, imitating perfectly a subnormal areola;
The nipple stays stable in shape and color, in my experience.
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