Case 04 2026: Full-Thickness Skin Graft for Areola Reconstruction: A Simple and Reliable Technique

Ajla Sabitovic; Nanja Gotland Sundstrup

Journal of Plastic, Breast & Reconstructive Surgery·Fagfællebedømte kirurgiske case-rapporter med åben adgangFagfællebedømt · Open access

Case 04 2026: Full-Thickness Skin Graft for Areola Reconstruction: A Simple and Reliable Technique · JPBRS

Case-rapport

Case 04 2026: Full-Thickness Skin Graft for Areola Reconstruction: A Simple and Reliable Technique

Ajla Sabitovic, Nanja Gotland Sundstrup

Publiceret 28. maj 2026194 visninger3 min læsning

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Resumé

This case describes the use of full-thickness skin graft for reconstruction of areola in a 64-year-old woman following right-sided mastectomy and delayed breast reconstruction with a DIEP flap. The patient preferred autologous reconstruction and declined tattooing or additional donor-site scars. Due to the light pigmentation on the contralateral areola, it was decided to shave the skin off as a full-thickness in the affected area, and let the following scaring in the area lead to a little change in pigmentation and contration. This approach avoided additional scarring while achieving an acceptable aesthetic result. Patient medical history A 64-year-old woman with a history of right-sided breast cancer underwent mastectomy in November 2022. In August 2024, the patient received a breast reconstruction with a free DIEP flap and a contralateral breast reduction. Nipple reconstruction using af full-thickness skin graft was subsequently performed in March 2025. In October 2025, the patient underwent areola reconstruction with a full-thickness skin graft on the reconstructed breast, combining the donor and recipient site around the nipple. Before and After Patient examination Clinical examination revealed aesthetically pleasing results following the DIEP flap and papil reconstruction as well as a light-colored contralateral areola. Pre-operative considerations It was considered to use a skin-graft from the groin due to its darker pigmentation, but the patient didn’t want any additional scares. Due to the light pigmentation on the contralateral areola, a local full-thickness skin graft was harvested at the recipient site. Postoperative scarring was expected to provide mild pigmentation change and contraction to improve areola definition. 1 Step 1 Preoperative markings performed with the patient in a standing position, showing the neo

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Pearls

1. Three-dimensional reconstruction potential.
2. Durability.
3. This technique is straight forward and well-suited for outpatient or clinical settings.
4. No additional scars are created.
5. Donor site morbidity is minimal.

Pitfalls

1. Surgical procedure compared with tattooing.
2. Donor/recipient site morbidity

Patient history

A 64-year-old woman with a history of right-sided breast cancer underwent mastectomy in November 2022. In August 2024, the patient received a breast reconstruction with a free DIEP flap and a contralateral breast reduction. Nipple reconstruction using af full-thickness skin graft was subsequently performed in March 2025. In October 2025, the patient underwent areola reconstruction with a full-thickness skin graft on the reconstructed breast, combining the donor and recipient site around the nipple.

Examination

Clinical examination revealed aesthetically pleasing results following the DIEP flap and papil reconstruction as well as a light-colored contralateral areola.

Pre-operative considerations

It was considered to use a skin-graft from the groin due to its darker pigmentation, but the patient didn’t want any additional scares. Due to the light pigmentation on the contralateral areola, a local full-thickness skin graft was harvested at the recipient site. Postoperative scarring was expected to provide mild pigmentation change and contraction to improve areola definition.

Trin 1 — Step 1

Preoperative markings performed with the patient in a standing position, showing the neoareola outlined 10 mm from the neopapilla corresponding to the size of the contralateral areola.

Trin 2 — Step 2

Preoperative image obtained with the patient in a supine position.

Trin 3 — Step 3

Referencer

Wolber et al. Nipple areola complex reconstruction with full thicknessskin graft and subcutaneous pedicled island flap. Ann Chir Plast Esthet 2009;54(4):365-9