Introduction: Reconstruction of the Nipple Areola Complex (NAC) is a crucial step in breast reconstruction, yet maintaining long-term nipple projection remains a common challenge, particularly in patients with limited reconstructive options.
Case Report: We report the case of a 57-year-old woman with a history of breast cancer treated with mastectomy, implant-based reconstruction, and adjuvant radiotherapy, who developed complete loss of nipple projection following NAC reconstruction with a local flap. Due to thin mastectomy skin flaps and refusal of contralateral nipple grafting, a combined approach using areolar tattooing and staged hyaluronic acid filler injections was performed, resulting in restoration and maintenance of nipple projection with no associated complications.
Conclusion: Hyaluronic acid filler represents a minimally invasive, safe, and reversible adjunct in nipple reconstruction, offering a valuable alternative for restoring nipple projection and shape when conventional surgical techniques are contraindicated or unsuccessful.