Projection and patient satisfaction using the "Hamburger" nipple reconstruction technique.

Maintaining projection and achieving patient satisfaction are two key challenges in nipple reconstruction. Skin flap techniques such as CV and star flaps are currently favoured. The "Hamburger" technique was described in 2007 using stacked conchal cartilage discs within a skin flap construct, but no longer-term outcomes have been published. We evaluate both projection and patient satisfaction following nipple reconstruction using this technique. Twenty-three nipple reconstructions performed between 2007 and 2009 were reviewed. A standard pre-tattooed cylinder skin pattern was used with 3 punch biopsies of conchal cartilage harvested through a post-auricular incision. At follow up, reconstructed nipples and donor sites were examined. Nipple projection was measured bilaterally. Patients completed a short questionnaire. Mean follow up was 24 months (9-31). Mean projection was 3.3 mm (range 0-5 mm) and was well matched to the contralateral nipple. No donor site keloid scarring was observed, however cartilage defects were easily palpable in all cases. Patients were satisfied or very satisfied with overall cosmesis in 91% of cases. They were satisfied or very satisfied with projection in 57% of cases. All patients found the donor site acceptable. With the "hamburger" technique medium-term projection was maintained in most cases and was comparable to published data for other techniques with or without cartilage. Patient satisfaction was high even when projection was not well maintained. This suggests that patient satisfaction and projection are not necessarily related. Donor site morbidity was low.