Thorek technique

Introduction: Introduced by Max Thorek in 1922, the Thorek technique for breast reduction utilizes a free nipple-areola complex (NAC) graft. Despite early criticism regarding aesthetic and functional outcomes, the technique has evolved and is now applied in various contexts, including oncoplastic surgery and transgender chest reconstruction. Objectives: This study reviews the Thorek technique and its contemporary applications and outcomes, focusing on its efficacy and complication rates. A retrospective analysis of procedures performed at the Breast Centre of Centro Hospitalar Universitário do Algarve was conducted. Methods: A retrospective cohort analysis of 27 free NAC graft procedures performed between 2022 and 2024 was conducted. Data included surgical technique, risk factors (e.g., smoking), sternal notch-to-nipple distance, and postoperative complications. Statistical analysis examined correlations between risk factors and outcomes. Results and Discussion: We had a 96.3 % success rate of free nipple graft procedures in our series. Of the 27 cases, 19% exhibited hypopigmentation and 19% had partial graft suffering, mainly localized to the distal component of the nipple. These complication rates are consistent with literature reports. Complete graft loss occurred in one case caused by complete loss of mammary reconstruction. Smoking was identified as a significant risk factor for graft complications. Most cases involved direct-to-implant (DTI) reconstruction, with favorable outcomes. Conclusion: The Thorek technique remains a valuable and reliable option for complex breast reconstruction, offering low complication rates and satisfactory aesthetic outcomes, particularly in high-risk cases such as those with large breasts or gender-affirming surgeries.