Yin–Yang NAC sharing: Full-thickness split graft from a single NAC for bilateral immediate reconstruction after skin-reducing mastectomy

Nipple-areola complex (NAC) reconstruction significantly contributes to postmastectomy body image and patient satisfaction. While nipple sharing has been described in delayed settings, its application in immediate reconstruction after skin-reducing mastectomy (SRM) is limited. We report the case of a 32-year-old BRCA1+ patient undergoing bilateral SRM with immediate implant-based reconstruction, in which a novel Yin-Yang nipple grafting technique was performed using the hypertrophic contralateral nipple. The donor nipple was harvested as a full-thickness nonvascularized graft, divided along a curved Yin-Yang fashion, and both halves were reshaped and grafted bilaterally to create two circular, natural-looking NACs. At the 6-month follow-up, the grafts showed complete take, satisfactory projection, and pigmentation. This report illustrates the feasibility and limitations of one-stage NAC reconstruction using a non-vascularized nipple graft technique in a selected patient undergoing SRM. (c) 2025 The Author(s). Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)