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Iacovelli S, De Palma G, De Santis V, Cutrignelli DA, Armenio A, Bove S, Comes MC, Fanizzi A, Vitale E, Massafra R, Ressa CM. Nipple-Areola Complex Reconstruction Using FixNip NRI Implant after Mastectomy: An Innovative Technique. Aesthetic Plast Surg 2024:10.1007/s00266-024-04418-y. [PMID: 39367231 DOI: 10.1007/s00266-024-04418-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 09/26/2024] [Indexed: 10/06/2024]
Abstract
BACKGROUND Nipple-areolar complex reconstruction is the final stage of breast reconstruction, and it improves quality of life in patients with post-mastectomy breast cancer. We present a case of a patient with breast cancer underwent breast reconstruction and subsequent nipple-areolar complex reconstruction with an innovative biocompatible smooth silicone implant specially designed for a long-lasting restoration of the nipple-areola complex called FixNip NRI. However, to our knowledge, nipple-areolar complex reconstruction with FixNip was not previously reported. INNOVATIVE TECHNIQUE We present an emerging technique applied on a patient with breast cancer treated with skin-sparing mastectomy and with immediate breast reconstruction using an expander and then exchanged expander to breast implant. FixNip nipple reconstruction implant is implanted for the reconstruction of the areola-nipple complex with local-regional anaesthesia. She did not develop any postoperatively short-term or long-term complications, and her nipple slowly underwent to a gradual and better definition of its profile. CONCLUSION This new approach regarding the reconstruction of the nipple-areola complex seems to be very promising in relation to both the degree of aesthetic satisfaction of patients and the ease of use by surgeons. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Serena Iacovelli
- Scientific Directorate, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Giuseppe De Palma
- Institutional BioBank, Experimental Oncology and Biobank Management Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy.
| | - Valerio De Santis
- Plastic and Reconstructive Surgery Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy.
| | | | - Andrea Armenio
- Plastic and Reconstructive Surgery Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Samantha Bove
- Biostatistics and Bioinformatic Lab, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Maria Colomba Comes
- Biostatistics and Bioinformatic Lab, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Annarita Fanizzi
- Biostatistics and Bioinformatic Lab, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Elsa Vitale
- Scientific Directorate, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Raffaella Massafra
- Biostatistics and Bioinformatic Lab, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Cosmo Maurizio Ressa
- Plastic and Reconstructive Surgery Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
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Cazzato V, Stocco C, Scian A, Bonat Guarini L, Sidoti GB, Renzi N, Ramella V, Papa G. Nipple Reconstruction Using the "Arrow Flap" Technique: Outcomes and Patients Satisfaction. Clin Breast Cancer 2024; 24:e226-e231. [PMID: 38503614 DOI: 10.1016/j.clbc.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 01/18/2024] [Indexed: 03/21/2024]
Abstract
INTRODUCTION Skin-sparing mastectomy (SSM) entails complete removal of the breast tissue and the nipple and areola complex (NAC) with preservation of as much of the overlying skin as possible. The preservation of the natural skin envelope during SSM improves the aesthetic outcome of immediate breast reconstruction, but the lack of NAC determines that the reconstructed breast remains anatomically incomplete with not always satisfactory final results. For this purpose, the aim of the present study was to investigate and evaluate the impact of nipple reconstruction after skin sparing and skin reducing mastectomy on the patients' perception and intimate life. MATERIALS AND METHOD This was a comparative single-center prospective study that involved 42 patients underwent NAC reconstruction after SSM. A pre- and postoperative quality-of-life and psychological questionnaires Breast-Q questionnaire (Breast Conserving therapy module) were given to all the patients before the surgery and 6 months after. The statistical analysis with chi-square test was performed. RESULTS After 6 months a prevalence of patients reported to be very satisfied in regard to shape, appearance, naturalness, projection, position and symmetry. The study shows an overall improvement in all the psychological items analyzed with statistically significant difference regarding: "patient's satisfaction," "self-confidence," "appearance of the breast." CONCLUSION The authors believe that the NAC reconstruction has useful functional and aesthetic results particularly appreciated by patients who feel demoralized after breast demolition surgery.
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Affiliation(s)
- Vito Cazzato
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy; Department of Plastic and Reconstructive Surgery, Azienda Sanitaria Universitaria Giuliano-Isontina, Trieste University Hospital, Trieste, Italy.
| | - Chiara Stocco
- Department of Plastic and Reconstructive Surgery, Azienda Sanitaria Universitaria Giuliano-Isontina, Trieste University Hospital, Trieste, Italy
| | - Alessandro Scian
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Luigi Bonat Guarini
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | | | - Nadia Renzi
- Department of Plastic and Reconstructive Surgery, Azienda Sanitaria Universitaria Giuliano-Isontina, Trieste University Hospital, Trieste, Italy
| | - Vittorio Ramella
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy; Department of Plastic and Reconstructive Surgery, Azienda Sanitaria Universitaria Giuliano-Isontina, Trieste University Hospital, Trieste, Italy
| | - Giovanni Papa
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy; Department of Plastic and Reconstructive Surgery, Azienda Sanitaria Universitaria Giuliano-Isontina, Trieste University Hospital, Trieste, Italy
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Go JY, Lee Y, Lee W. A Novel Method Using the Petal Pattern for Contouring a Domed Nipple in Tuberous Breasts. Plast Reconstr Surg 2024; 153:1254-1257. [PMID: 37335586 DOI: 10.1097/prs.0000000000010834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
SUMMARY The main cause of domed nipples is increased pressure, which causes the breast tissue to herniate toward the nipple-areola complex. It appears as a characteristic of a tuberous breast rather than occurring alone, and the boundary between the nipple and areolar region is unclear. The authors present a method using petal patterns for single-stage aesthetic correction of domed nipples. The method is designed by placing the left and right corners of each petal at the desired position as the edge boundary of the nipple. The number and width of petals are adjusted so that the obtuse angle between the nipple and areola is 90 to 100 degrees. The areolar and soft tissues in the designed patterns are excised together with the skin and collected using a barbed suture in a specially designed suture technique. Surgery is completed after the skin is sutured using nylon. Case examples are presented to illustrate the appropriate candidate selection and results. Overall, the aesthetic results are positive in terms of shape and patient satisfaction. This method is useful for contouring domed nipples. This new design is simple, leaves minimal scars, and provides the surgeon with an additional option for treating tuberous breasts. It can be used alone or along with breast augmentation.
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Affiliation(s)
| | | | - Won Lee
- Yonsei E1 Plastic Surgery Clinic
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Chu C, Zhang W, Zhang Y, Zou Q, Xu H, Jin Y. Staged Immediate Nipple Reconstruction With Tube Flap in Immediate Deep Inferior Epigastric Artery Perforator Flap Breast Reconstruction. Ann Plast Surg 2024; 92:274-278. [PMID: 38394267 DOI: 10.1097/sap.0000000000003768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
BACKGROUND In the setting of immediate breast reconstruction by deep inferior epigastric artery perforator (DIEP) flap, the excessive DIEP flap skin is de-epithelialized and then buried under the mastectomy skin. In this study, by virtue of tube flap technique, we hypothesize that the skin supposed to be abandoned could be transferred to the apex of reconstructed breast mound for nipple reconstruction. METHODS A total of 60 female patients were recruited between January 2019 and December 2020. All these patients underwent mastectomy including nipple-areola complex and immediate DIEP flap breast reconstruction. A ladder-shaped pedicled flap was raised from the DIEP flap and rolled into a tube. The free end of tube flap was inset into the future nipple position of the reconstructed breast mound 1 week later. After revascularization for 1 month, we divided the previous pedicle and used the tube on the apex of the breast mound to recreate a new nipple. RESULTS All reconstructed breasts and nipples survived well postoperatively. The average nipple projection was 12.5 ± 2.0 mm immediately after the surgery, which gradually decreased to 9.4 ± 1.5 mm at 1-year follow-up, with the projection loss from the initial measurement as 24.9% ± 1.8%. In total, 51 patients considered the overall impression of breast and nipple reconstruction to be very good or good. CONCLUSIONS We provided an ideal technique that could improve the maintenance of reconstructed nipple projection and have aesthetically acceptable outcomes, without DIEP flap tissue loss, breast mound distortion, or additional scars.
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Affiliation(s)
- Chengyu Chu
- From the Department of Thyroid and Breast Surgery, General Surgery, Huashan Hospital, Fudan University
| | - Wei Zhang
- From the Department of Thyroid and Breast Surgery, General Surgery, Huashan Hospital, Fudan University
| | - Yi Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiang Zou
- From the Department of Thyroid and Breast Surgery, General Surgery, Huashan Hospital, Fudan University
| | - Hua Xu
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiting Jin
- From the Department of Thyroid and Breast Surgery, General Surgery, Huashan Hospital, Fudan University
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Yoo H, Park S, Chang H. Nipple reconstruction using modified C-V flap with purse-string sutures for maintenance of long-term nipple projection. J Plast Reconstr Aesthet Surg 2023; 84:62-70. [PMID: 37327734 DOI: 10.1016/j.bjps.2023.04.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 04/18/2023] [Accepted: 04/18/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND The most common concern in nipple reconstruction is the loss of long-term nipple projection. This study aimed to demonstrate a novel method of nipple reconstruction using a modified C-V flap combined with purse-string sutures in the nipple base to maintain nipple projection. METHODS From January 2018 to July 2021, patients who underwent nipple reconstruction using the novel modified C-V flap method and conventional C-V flap were retrospectively reviewed. The ratio of projection at the 3, 6, and 12-month postoperative follow-up to the initial nipple projection was calculated and compared. RESULTS A total of 116 patients were included in this study, which was comprised of 41 patients in the conventional C-V flap group (conventional) and 75 patients in the modified C-V flap with purse-string sutures group (modified). The modified group showed a significantly higher ratio of nipple projection maintenance at postoperative 3 months (79.82%, conventional; 87.25%, modified; p < 0.001), 6 months (68.29%, conventional; 73.18%, modified; p < 0.001), and 12 months (53.98%, conventional; 60.19%, modified; p < 0.001), and a significantly lower revision rate (13/75 patients, 17.33%) than the conventional group (16/41 patients, 39.02%) (p = 0.009) during a mean of 17.67-month follow-up. CONCLUSIONS Nipple reconstruction using a modified C-V flap with purse-string sutures in the nipple base is a safe and effective method for the maintenance of long-term nipple projection owing to the reduction and stabilization of the nipple base.
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Affiliation(s)
- Hyokyung Yoo
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sunkyu Park
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hak Chang
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Oganesyan RV, Lellouch AG, Acun A, Lupon E, Taveau CB, Burlage LC, Lantieri LA, Randolph MA, Cetrulo CL, Uygun BE. Acellular Nipple Scaffold Development, Characterization, and Preliminary Biocompatibility Assessment in a Swine Model. Plast Reconstr Surg 2023; 151:618e-629e. [PMID: 36472499 PMCID: PMC10859846 DOI: 10.1097/prs.0000000000009998] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The standard in nipple reconstruction remains the autologous skin flap. Unfortunately, the results are not satisfying, with up to 75% loss of nipple projection over time. Existing studies investigated the use of primates as a source of implants. The authors hypothesized that the porcine nipple can serve as a perfect shape-supporting implant because of functional similarities to the human nipple. A decellularization protocol was developed to obtain an acellular nipple scaffold (ANS) for nipple reconstruction. METHODS Tissue samples were collected from eight disease-free female Yorkshire pigs (60 to 70 kg) and then decellularized. The decellularization efficiency and extracellular matrix characterization was performed histologically and quantitatively (DNA, total collagen, elastin, and glycosaminoglycan content). In vitro and in vivo biocompatibility was determined by human dermal fibroblast culture and subcutaneous implantation of six ANSs in a single Yorkshire pig (60 to 70 kg), respectively. Inflammation and adverse events were monitored daily based on local clinical signs. RESULTS The authors showed that all cellular structures and 96% of DNA [321.7 ± 57.6 ng DNA/mg wet tissue versus 11.7 ± 10.9 ng DNA/mg wet tissue, in native and ANS, respectively ( P < 0.001)] can be successfully removed. However, this was associated with a decrease in collagen [89.0 ± 11.4 and 58.8 ± 9.6 μg collagen/mg ( P < 0.001)] and elastin [14.2 ± 1.6 and 7.9 ± 2.4 μg elastin/mg ( P < 0.05)] and an increase in glycosaminoglycan content [5.0 ± 0.7 and 6.0 ± 0.8 ng/mg ( P < 0.05)]. ANS can support continuous cell growth in vitro and during preliminary biocompatibility tests in vivo. CONCLUSION This is a preliminary report of a novel promising ANS for nipple reconstruction, but more research is needed to validate results. CLINICAL RELEVANCE STATEMENT Breast cancer is very common among women. Treatment involves mastectomy, but its consequences affect patient mental well-being, and can lead to depression. Nipple-areola complex reconstruction is critical, and existing methods lead to unsatisfactory outcomes.
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Affiliation(s)
- Ruben V. Oganesyan
- Center for Engineering in Medicine and Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School
- Shriners Children’s Boston
| | - Alexandre G. Lellouch
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School
- Vascularized Composite Allotransplantation Laboratory, Center for Transplantation Sciences, Massachusetts General Hospital, Harvard Medical School
- Department of Plastic Surgery, European George Pompidou Hospital, University of Paris
- Shriners Children’s Boston
| | - Aylin Acun
- Center for Engineering in Medicine and Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School
- Shriners Children’s Boston
- Department of Biomedical Engineering, Widener University
| | - Elise Lupon
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School
- Vascularized Composite Allotransplantation Laboratory, Center for Transplantation Sciences, Massachusetts General Hospital, Harvard Medical School
- University Institute of Locomotor and Sport (IULS), Pasteur Hospital
- Shriners Children’s Boston
| | - Corentin B. Taveau
- Department of Plastic Surgery, European George Pompidou Hospital, University of Paris
| | - Laura C. Burlage
- Center for Engineering in Medicine and Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School
- Vascularized Composite Allotransplantation Laboratory, Center for Transplantation Sciences, Massachusetts General Hospital, Harvard Medical School
- Shriners Children’s Boston
- Department of Plastic Surgery, Amsterdam University Medical Center
| | - Laurent A. Lantieri
- Department of Plastic Surgery, European George Pompidou Hospital, University of Paris
| | - Mark A. Randolph
- Vascularized Composite Allotransplantation Laboratory, Center for Transplantation Sciences, Massachusetts General Hospital, Harvard Medical School
- Shriners Children’s Boston
| | - Curtis L. Cetrulo
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School
- Vascularized Composite Allotransplantation Laboratory, Center for Transplantation Sciences, Massachusetts General Hospital, Harvard Medical School
- Shriners Children’s Boston
| | - Basak E. Uygun
- Center for Engineering in Medicine and Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School
- Shriners Children’s Boston
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Preliminary report of de novo adipogenesis using novel bioabsorbable implants and image evaluation using a porcine model. J Artif Organs 2022; 25:245-253. [PMID: 35235081 PMCID: PMC9418277 DOI: 10.1007/s10047-022-01313-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/17/2022] [Indexed: 11/24/2022]
Abstract
Our bioabsorbable poly-l-lactic acid (PLLA) mesh implants containing collagen sponge are replaced with adipose tissue after implantation, and this is an innovative method for breast reconstruction. In this preliminary study, we investigated the formation of adipose tissue and evaluated the process via multimodal images in a porcine model using an implant aggregate to generate the larger adipose tissue. The implant aggregate consists of PLLA mesh implants containing collagen sponge and a poly-glycolic acid woven bag covering them. We inserted the implant aggregates under the porcine mammary glands. Magnetic resonance imaging (MRI), ultrasonography (USG), and 3-dimensional (3D) surface imaging and histological evaluations were performed to evaluate the formation of adipose tissue over time. The volume of the implant aggregate and the formed adipose tissue inside the implant aggregate could be evaluated over time via MRI. The space within the implant aggregate was not confirmed on USG due to the acoustic shadow of the PLLA threads. The change in volume was not confirmed precisely using 3D surface imaging. Histologically, the newly formed adipose tissue was confirmed on the skin side of the implant aggregate. This implant aggregate has the ability to regenerate adipose tissue, and MRI is an appropriate method for the evaluation of the volume of the implant aggregation and the formation of adipose tissue.
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Hwang E, Yang JY, Ha HJ, Kim CW, Lee JW. Nipple Reconstruction Using the Semilunar Flap and Omega-shaped Acellular Dermal Matrix Strut. Aesthetic Plast Surg 2022; 46:152-160. [PMID: 34269845 DOI: 10.1007/s00266-021-02438-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 06/19/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Various operative methods exist for nipple reconstruction. Selection of an appropriate skin flap and core strut material is imperative in achieving a satisfactory outcome in nipple reconstruction. Long-term maintenance of nipple projection requires further investigation by surgeons. We propose a new technique that uses a semilunar flap and omega-shaped acellular dermal matrix (ADM). METHODS Total 53 nipples were reconstructed by this method. An omega-shaped ADM strut was inserted into the barrel made by a semilunar flap. The footplates of omega-shaped ADM struts were spread out under the subcutaneous tissue of the donor site of the semilunar flap to support the dome of the omega strut. RESULTS The mean maintenance rate of nipple projection was 95.12 ± 6.30% at 3 weeks, 80.60 ± 8.93% at 3 months, and 71.70 ± 8.67% at 6 months postoperatively when compared to the projection observed in the immediate postoperative period. Thirty-five patients (66.0%) showed a maintenance rate over 70% at 6 months post operation, with most patients (94.3%) demonstrating a maintenance rate greater than 60%. CONCLUSIONS Our study with the omega-shaped ADM strut showed superior maintenance rates of projection when compared to other studies on that used AlloDerm® as a core strut for nipple reconstruction. Omega-shaped struts, when made with cross-linked thick ADM, supported the skin flap quite well. We propose that our method combining the semilunar flap with an omega-shaped ADM may be a good option for nipple reconstruction. LEVEL OF EVIDENCE IV: "This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 ."
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Secondary nipple reconstruction using two surgical techniques. Arch Plast Surg 2021; 48:590-598. [PMID: 34818704 PMCID: PMC8627941 DOI: 10.5999/aps.2021.00304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 07/07/2021] [Indexed: 11/10/2022] Open
Abstract
Background Although the initial projection after primary nipple reconstruction is excellent, nipple projection gradually flattens in most cases due to multiple causes. Although various methods have been reported to rebuild the nipple after nipple flattening, the most effective method of secondary nipple reconstruction remains unknown. The aim of this study was to review our institution’s experiences with secondary nipple reconstruction. Methods We conducted a retrospective review from March 2012 to January 2019. We performed secondary nipple reconstruction if the primary reconstructed nipple height differed by more than 6 mm from the normal nipple height. We chose the method of nipple revision according to the degree of tissue scarring and the remaining nipple projection. Results We performed secondary nipple reconstruction on a total of 27 nipples, using pursestring sutures for 19 nipples and star flaps in eight nipples. The median follow-up period was 8 months (range, 6–19 months) after the final nipple reconstruction. Among the 19 nipples reconstructed using purse-string sutures, 10 (53%) demonstrated acceptable projection of more than 5 mm. Among the eight nipples reconstructed using star flaps, six (75%) showed acceptable projection of more than 5 mm. Most of the patients (73%) were satisfied (scores of 4 or 5) with the nipple reconstruction overall. Conclusions Few studies have presented favorable outcomes of secondary nipple reconstruction. When the star flap and purse-string suture methods were used depending on the remaining nipple height and scarring, appropriate projection could be achieved.
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Lee JH, Ryu JY, Lee JH, Lee J, Park HY, Yang JD, Lee JS. Simultaneous nipple reconstruction in autologous breast reconstruction. Gland Surg 2021; 10:2966-2977. [PMID: 34804884 PMCID: PMC8575712 DOI: 10.21037/gs-21-338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/26/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Reconstruction of the nipple-areola complex is the final step in surgical restoration of the breast. Nipple-areola reconstruction was previously done after an interval of several months using variable techniques, often resulting in low projection and flattened breast mound over time. We present algorithm of simultaneous nipple reconstruction (SNR) that leaves adequate residual projection and naturally shaped breast mound. METHODS Forty patients underwent a skin-sparing mastectomy and nipple excision between October 2016 and December 2020. In the control group, 21 patients underwent delayed nipple reconstruction for 6 months after breast reconstruction. The experimental group of 19 patients underwent nipple and breast reconstruction simultaneously. We collected relevant information and photographs of nipple profiles of both groups in the preoperative, postoperative 6-month, and postoperative 1-year time periods. We also examined the ratio between the reconstructed and contralateral nipples. RESULTS Scores regarding patient satisfaction questionnaire averaged higher in experimental groups to every category. The control group's scores gradually declined over time and the experimental group showed lesser decline. At the 1-year postoperative follow-up, the mean projection of the immediately reconstructed nipple was approximately the same as the contralateral nipple at 91%, whereas the delayed reconstructed nipple resulted in a 77% ratio. CONCLUSIONS Nipple reconstruction should no longer be considered as a secondary complement to immediate breast reconstruction. The nipple appears to be essential component of breast reconstruction for patient. SNR with immediate breast reconstruction is a simple and reliable technique, giving stable aesthetic results over time.
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Affiliation(s)
- Jong Ho Lee
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jeong Yeop Ryu
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jung Ho Lee
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jeeyeon Lee
- Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Ho Yong Park
- Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jung Dug Yang
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Joon Seok Lee
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
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Abstract
Tattooing is a permanent form of body art applied onto the skin with a decorative ink, and it has been practiced from antiquity until today. The number of tattooed people is steadily increasing as tattoos have become popular all over the world, especially in Western countries. Tattoos display distinctive designs and images, from protective totems and tribal symbols to the names of loved or lost persons or strange figures, which are used as a means of self-expression. They are worn on the skin as a lifelong commitment, and everyone has their own reasons to become tattooed, whether they be simply esthetic or a proclamation of group identity. Tattoos are representations of one’s feelings, unconscious conflicts, and inner life onto the skin. The skin plays a major role in this representation and is involved in different ways in this process. This article aims to review the historical and psychoanalytical aspects of tattoos, the reasons for and against tattooing, medical and dermatological implications of the practice, and emotional reflections from a psychodermatological perspective.
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Paolini G, Firmani G, Briganti F, Sorotos M, Santanelli di Pompeo F. Guiding Nipple-Areola Complex Reconstruction: Literature Review and Proposal of a New Decision-Making Algorithm. Aesthetic Plast Surg 2021; 45:933-945. [PMID: 33216178 PMCID: PMC8144123 DOI: 10.1007/s00266-020-02047-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 11/05/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Nipple-areola complex reconstruction (NAR) most commonly represents the finishing touch to breast reconstruction (BR). Nipple presence is particularly relevant to the patient's psyche, beyond any shadow of doubt. Many reconstructive options have been described in time. Surgery is easy, but final result is often disappointing on the long run. METHODS The goal of this manuscript is to analyze and classify knowledge concerning NAR techniques and the factors that influence success, and then to elaborate a practical evidence-based algorithm. Out of the 3136 available articles as of August 8th, 2020, we selected 172 manuscripts that met inclusion criteria, which we subdivided into 5 main topics of discussion, being the various NAR techniques; patient factors (including patient selection, timing and ideal position); dressings; potential complications and finally, outcomes/patient satisfaction. RESULTS We found 92 articles describing NAR techniques, 41 addressing patient factors (out of which 17 discussed patient selection, 14 described ideal NAC location, 10 described appropriate timing), 10 comparing dressings, 7 studying NAR complications, and 22 addressing outcomes and patient satisfaction. We elaborated a comprehensive decision-making algorithm to help narrow down the choice among NAR techniques, and choose the correct strategy according to the various scenarios, and particularly the BR technique and skin envelope. CONCLUSIONS No single NAR technique provides definitive results, which is why we believe there is no "end-all be-all solution". NAR must be approached as a case-by-case situation. Furthermore, despite NAR being such a widely discussed topic in scientific literature, we still found a lack of clinical trials to allow for more thorough recommendations to be elaborated. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Affiliation(s)
- Guido Paolini
- Faculty of Medicine and Psychology, Plastic Surgery Department, Sapienza University of Rome-Sant'Andrea Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Guido Firmani
- Faculty of Medicine and Psychology, Plastic Surgery Department, Sapienza University of Rome-Sant'Andrea Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy.
| | - Francesca Briganti
- Faculty of Medicine and Psychology, Plastic Surgery Department, Sapienza University of Rome-Sant'Andrea Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Michail Sorotos
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", PhD School of Translational Medicine of Development and Active Ageing, Università degli Studi di Salerno, Salerno, Italy
| | - Fabio Santanelli di Pompeo
- Chair of Plastic Surgery, Faculty of Medicine and Psychology, Sapienza University of Rome - Sant'Andrea Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
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Li Y, Juan A. Invited Discussion on: 3D Nipple-Areolar Tattoo: Its Technique, Outcomes, and Utilization. Aesthetic Plast Surg 2021; 45:459-461. [PMID: 33201293 DOI: 10.1007/s00266-020-02034-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 10/26/2020] [Indexed: 10/23/2022]
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Tan YY, Chin YR, Bajaj K, Thomas S. Patient-reported outcomes for nipple reconstruction: Review of literature. Surgeon 2021; 19:e245-e255. [PMID: 33423920 DOI: 10.1016/j.surge.2020.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/04/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND There is currently no validated patient-reported outcome measure (PROM) that is specific to nipple-areola complex (NAC) reconstruction. This paper evaluates all patient-reported outcomes for NAC reconstruction in the literature. METHODS Systematic literature searches of The Cochrane Central Register of Controlled Trials, MEDLINE and World Health Organization International Clinical Trials Registry Platform were conducted to identify all primary studies with patient-reported outcomes for NAC reconstruction. The primary outcome measures were patient satisfaction rates for appearance and symmetry of NAC reconstruction. RESULTS Fifty-nine papers were included in this review. Reported patient satisfaction was generally high, with the pooled average satisfaction rate for appearance being 81.9% and symmetry 80.3%. 89.5% of respondents would do it again and 94.8% would recommend it to others. There is no standardised or validated PROM specific to NAC reconstruction and this contributes to a lack of conclusive findings from studies in this area. CONCLUSION There is a need for a validated PROM that is specific to NAC reconstruction, in order to serve as a standardised outcome assessment to guide further research and improve patient care.
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Affiliation(s)
- Yan Yu Tan
- Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham B15 2TH, UK.
| | - Ye Ru Chin
- Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham B15 2TH, UK
| | - Kuljyot Bajaj
- Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham B15 2TH, UK
| | - Sunil Thomas
- Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham B15 2TH, UK
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Wolf O, Liu J, Legarda C, Kronowitz SJ. The spare-parts technique: A safe and efficient single-stage nipple and areola reconstruction. J Plast Reconstr Aesthet Surg 2020; 73:1871-1878. [PMID: 32601013 DOI: 10.1016/j.bjps.2020.05.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 03/15/2020] [Accepted: 05/09/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The authors hypothesized that optimization of nipple-areolar reconstruction using full-thickness skin graft and cartilage graft can be completed safely in a single-stage procedure. METHODS A retrospective analysis of abdominal-based flap breast reconstruction patients who underwent nipple-areolar reconstruction (NAR) using the modified double-opposing tab (mDOT)1 flap technique was conducted. Complication rates were compared between patients who underwent NAR in a traditional staged procedure versus a single stage. The single-stage group of patients had NAR performed at the time of revision surgery. Reconstruction was performed with full-thickness skin graft from the abdominal standing-cone deformity and costal cartilage that was removed at the time of breast reconstruction and banked subcutaneously until the revision surgery. RESULTS In this study, 1,233 nipple reconstructions were reviewed, of which 113 procedures using themDOT technique were analyzed. No significant differences in complication rates were found between the single-stage and the traditional staged NAR, including the risk of total loss of reconstruction or delayed skin graft take. However, the risk of delayed wound healing of the nipple reconstruction was higher in the single-stage group. CONCLUSIONS Our study shows that optimizing NAR results by adding cartilage to the nipple construct and enhancing the areolar component by full-thickness skin grafting can be achieved safely in a single stage at the time of flap revision. This represents potential for better long-term nipple projection and better areolar texture mimicry of NAR for breast reconstruction patients.
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Affiliation(s)
- Omer Wolf
- Department of Plastic Surgery, Yitzhak Shamir Medical Center, formerly known as Assaf Harofeh Medical Center, Zerifin, Israel.
| | - Jun Liu
- Department of Plastic Surgery, M.D. Anderson Cancer Center, Houston, TX, United States
| | - Carolina Legarda
- Department of Plastic Surgery, Souraksy Medical Center, Tel Aviv, Israel
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Sisti A. Nipple-Areola Complex Reconstruction. ACTA ACUST UNITED AC 2020; 56:medicina56060296. [PMID: 32560062 PMCID: PMC7353867 DOI: 10.3390/medicina56060296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/28/2020] [Accepted: 06/10/2020] [Indexed: 12/04/2022]
Abstract
The reconstruction of the nipple–areola complex is the last step in the breast reconstruction process. Several techniques have been described over the years. The aim of this review is to provide clarity on the currently available reconstructive options.
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Affiliation(s)
- Andrea Sisti
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH 44195, USA
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Choi BG, Kim IK. An innovative nipple reconstruction technique for minimizing postoperative scars: The teardrop flap. ARCHIVES OF AESTHETIC PLASTIC SURGERY 2020. [DOI: 10.14730/aaps.2019.01991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Allogeneic and Alloplastic Augmentation Grafts in Nipple-Areola Complex Reconstruction: A Systematic Review and Pooled Outcomes Analysis of Complications and Aesthetic Outcomes. Aesthetic Plast Surg 2020; 44:308-314. [PMID: 31722063 DOI: 10.1007/s00266-019-01539-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 10/31/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND With advancements in materials engineering, many plastic surgeons have looked to allogeneic tissue and alloplastic materials as a possible source of structure for long-lasting nipple-areola complex reconstruction. Furthermore, in light of the recent mandate from the Food and Drug Administration restricting the marketing and direct indication of acellular dermal matrices (ADMs) in breast reconstruction, we sought to highlight the overall safety and efficacy demonstrated in the existing literature surrounding all alloplastic materials in nipple-areola complex reconstruction. In this study, the authors conduct a systematic review and pooled outcomes analysis on allogenic and alloplastic implant materials utilized to achieve long-lasting nipple projection stratified by specific material used and respective outcomes. METHODS A comprehensive systematic review on allogenic and synthetic materials data utilized in nipple reconstruction was conducted utilizing Medline/PubMed database. Articles were stratified by (1) alloplastic material, as well as (2) objective and patient-reported outcomes. RESULTS A total of 592 nipple-areola complexes on 482 patients were featured in 15 case series. In all studies, alloplastic or allograft material was utilized to achieve and maintain nipple projection. Subjective measurements revealed a patient satisfaction rate of 93.3% or higher with the majority of patients being very satisfied with their reconstruction. The alloplastic and allograft implants analyzed had an overall complication rate of 5.3% across all materials used. The most common complication reported was flap or graft necrosis with a pooled rate of 2.5%. Overall, the Ceratite implant presented with the highest complication rate (18%) including flap/graft necrosis (13%) and extrusion of the artificial bone (5%). Other rigid implants such as the biodesign nipple reconstruction cylinder reported complications of extrusion (3.6%), projection loss requiring revision (2.5%), wound dehiscence/drainage (1.5%), flap or graft necrosis (1.0%) and excessive bleeding (0.5%). ADM implants had reported complications of both insufficient projection (0.8%) and excessive projection (1.6%), which required surgical revision. Injectable materials had minimal reported complications of pain during injection (0.8%) with Radiesse and a false-positive PET scan result (0.8%) with DermaLive. CONCLUSIONS Allogeneic and alloplastic grafts are a reliable means of achieving satisfactory nipple projection, with a relatively low overall complication profile. The use of Ceratite (artificial bone) led to the highest complication rates. Further clinical studies are necessary to better understand the feasibility and longer-term outcomes of the use of allogeneic and synthetic augmentation grafts to improve nipple projection. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Mohan A, Ghaffari H, Ho-Asjoe M. Strattice reconstructive tissue matrix to maintain nipple projection—what do patients think? EUROPEAN JOURNAL OF PLASTIC SURGERY 2019. [DOI: 10.1007/s00238-019-01534-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Kim JH, Baek SE, Oh DY. Thermoplastic nipple splint: A simple method of maintaining nipple projection. ARCHIVES OF AESTHETIC PLASTIC SURGERY 2019. [DOI: 10.14730/aaps.2019.01704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
Reconstruction of the nipple-areola complex is the culmination of a long road for patients who have suffered breast cancer. The postoperative dressing of the reconstructive nipple must protect it from mechanical forces, trauma, and infection. A broad array of dressings has been used for the reconstructed nipple. The authors propose the use of a readily available adhesive eye protector as a simple and cost-effective dressing for the reconstructed nipple-areola complex.
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Dong J, Wang T, Zhang Y, Xu H, He J. Staged immediate nipple reconstruction with tube flap in secondary autologous breast reconstruction. J Plast Surg Hand Surg 2019; 53:204-207. [PMID: 30870049 DOI: 10.1080/2000656x.2019.1582423] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In the setting of secondary breast reconstruction by deep inferior epigastric artery perforator (DIEP) flap, the mastectomy skin is usually deepithelialized and buried under the reconstructed breast. In this study, by virtue of tube flap technique, we hypothesize that an amount of mastectomy skin could be transferred to the apex of reconstructed breast mound for nipple reconstruction. A total of 30 female postmastectomy patients were recruited between June 2012 and August 2015. A bipedicle DIEP flap was harvested and folded upward to reconstruct the breast. An inferiorly based mastectomy flap was raised and rolled into a tube. The free end of the flap was sutured to the reconstructed breast mound to allow revascularization. After serial stages, a sufficient tissue bulk from the mastectomy flap was transferred to the apex of the breast mound and remolded into a new nipple. Reconstructed breasts and nipples survived well postoperatively. The mean nipple projection was 9.2 ± 2.7 mm at the 1-year follow-up. In total 24 patients ranked the overall nipple and breast reconstruction to be very good or good. Based on DIEP flap breast reconstruction, the staged immediate nipple reconstruction with local mastectomy tube flap could maintain a long term residual projection with aesthetically acceptable outcomes.
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Affiliation(s)
- Jiasheng Dong
- a Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai JiaoTong University School of Medicine , Shanghai , P. R. China
| | - Tao Wang
- a Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai JiaoTong University School of Medicine , Shanghai , P. R. China
| | - Yi Zhang
- a Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai JiaoTong University School of Medicine , Shanghai , P. R. China
| | - Hua Xu
- a Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai JiaoTong University School of Medicine , Shanghai , P. R. China
| | - Jinguang He
- a Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai JiaoTong University School of Medicine , Shanghai , P. R. China
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Heo JW, Park SO, Jin US. A Nipple-Areolar Complex Reconstruction in Implant-Based Breast Reconstruction Using a Local Flap and Full-Thickness Skin Graft. Aesthetic Plast Surg 2018; 42:1478-1484. [PMID: 29948101 DOI: 10.1007/s00266-018-1162-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 05/19/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Nipple-areolar complex reconstruction is the final step of the reconstructive procedure in breast cancer patients. Nowadays, a combination of a local flap for nipple reconstruction and skin grafting or tattooing for areola reconstruction is deemed a first choice. In this paper, we are combining the techniques of local flap and full-thickness skin graft from the upper inner thigh for simultaneous reconstruction of the nipple and areola. PATIENTS AND METHODS From January, 2016 to December, 2017, 23 female patients with an absent unilateral nipple-areolar complex due to post-oncological mastectomy and immediate implant-based breast reconstruction were subjects of the study. On an out-patient clinic basis, the percentage of the nipple projection loss was calculated at the intervals of 3 , 6 and 12 months postoperatively. At the final visit, the patient's subjective satisfaction on the reconstructed areola compared to the normal contralateral side was evaluated using a visual analogue scale. RESULTS Over the course of time, the mean nipple projection loss was 20.16 ± 12.88, 31.78 ± 11.63 and 34.69 ± 12.01% at 3 , 6 and 12 months postoperatively, respectively. Patients' overall satisfaction on the grafted areola was as follows; the largest number of patients (8 patients) had a 'good' satisfaction 12-months postoperatively. Out of 21 patients, those who considered the result to be 'poor' and 'disappointing' each accounted for 1 and 3 patients. CONCLUSION The combination of nipple-areolar complex reconstruction technique introduced in this study has proven to be a safe and efficacious alternative in patients with implant-based reconstruction requiring small- to medium-sized nipple projection, especially when the skin envelope is too tight for a local flap only. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Jae-Woo Heo
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Seong Oh Park
- Department of Plastic and Reconstructive Surgery, Hanyang University Seoul Hospital, Seoul, Republic of Korea
| | - Ung Sik Jin
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, Republic of Korea.
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Yoon JS, Chang JW, Ahn HC, Chung MS. Modified C-H flap for simultaneous nipple reconstruction during autologous breast reconstruction: Surgical tips for safety and cosmesis. Medicine (Baltimore) 2018; 97:e12460. [PMID: 30235735 PMCID: PMC6160055 DOI: 10.1097/md.0000000000012460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Reconstruction of the nipple-areolar complex is the final stage of breast reconstruction. Nipple reconstruction is usually performed several months after breast reconstruction, because simultaneous reconstruction is thought to be risky. Here, we introduce our experiences of 1-stage procedures with immediate reconstruction of the nipple-areolar complex during autologous breast reconstruction. METHODS Between 2008 and 2015, 51 mastectomy patients underwent 1-stage breast and nipple reconstruction. All cases were reconstructed immediately with autologous tissue for the breast mound. The patients were divided into 2 groups according to the method of nipple-areolar complex reconstruction. In group A, 23 cases were reconstructed with a classical C-H flap, also known as the Hammond flap. In group B, 28 cases were reconstructed with a modified C-H flap, which is the evolved form of the classical Hammond flap. The nipple-areolar complex was evaluated preoperatively, immediately postoperatively, and 1 year postoperatively. Postoperative complications were also evaluated. RESULTS The mean projection of the reconstructed nipple decreased by approximately 50% in group A and 38% in group B during the postoperative 1 year. However, the reconstructed nipple width and areolar diameter did not show a significant change in either group. Group A showed 26% of complication rate and 17% of revision rate, whereas group B showed 11% of complication rate and 4% of revision rate. However, no major complications such as complete necrosis of the reconstructed nipple, were observed in any patients. CONCLUSION The modified technique group showed superior results in terms of safety and cosmesis. With our modified C-H flap method, simultaneous breast and nipple reconstruction is safe and has satisfactory results.
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Affiliation(s)
- Jung Soo Yoon
- Department of Plastic and Reconstructive Surgery, Hanyang University Medical Center, Hanyang University College of Medicine, Seoul
| | - Jung Woo Chang
- Department of Plastic and Reconstructive Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri
| | - Hee Chang Ahn
- Department of Plastic and Reconstructive Surgery, Hanyang University Medical Center, Hanyang University College of Medicine, Seoul
| | - Min Sung Chung
- Department of Surgery, Hanyang University Medical Center, Hanyang University College of Medicine, Seoul, Korea
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Osborn LP, Cohen PR. Emotional healing with unconventional breast tattoos: The role of temporary tattoos in the recovery process after breast carcinoma and mastectomy. Clin Dermatol 2018; 36:426-429. [PMID: 29908584 DOI: 10.1016/j.clindermatol.2017.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The healing process after breast cancer treatment is predominantly focused toward the physical changes to the body that a patient has experienced. Breast reconstructions are considered standard of care after mastectomy, and the nipple and areolar complex is often reconstructed as well, using a combination of skin graft and tattoo. A patient who decided to forego nipple reconstruction and areolar tattooing and instead chooses to apply decorative temporary tattoos to her breast reconstruction is described. Compared with permanent tattoos, these unconventional tattoos allow the patient to change the design to fit her mood. Unconventional tattoos are an alternative and creative approach to the healing process, in which artistic and individual expression allows the patient to embrace the physical change she has undergone as a breast cancer survivor.
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Affiliation(s)
| | - Philip R Cohen
- Department of Dermatology, University of California at San Diego School of Medicine, La Jolla, CA
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Kluger N, De Cuyper C. A Practical Guide About Tattooing in Patients with Chronic Skin Disorders and Other Medical Conditions. Am J Clin Dermatol 2018; 19:167-180. [PMID: 28993993 DOI: 10.1007/s40257-017-0326-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
With tattoos becoming increasingly mainstream, dermatologists are more and more often consulted by patients who are considering getting an ornamental, cosmetic, or even a medical tattoo, and who subsequently ask for advice. This includes not only patients with chronic skin diseases such as psoriasis or atopic dermatitis but also patients with other medical conditions. This review first explores the reasons why patients may want to get a tattoo and aims to offer some key information to dermatologists on what they should know about tattooing and the main risks associated with this procedure. Second, the risks and recommendations of tattooing in patients with specific skin diseases are described more in detail, and the relative and strict contraindications discussed, including the necessity to discontinue certain treatments that could influence the outcome of the procedure and the final result. Our aim was to provide dermatologists with the current knowledge they need to help their patients make adequate and informed choices on skin art, focusing specifically on considerations in patients with chronic skin conditions. Finally, other aspects regarding some general systemic conditions and concomitant diseases that the patient could present are also addressed. In particular, the risks of tattooing in patients with diabetes, coagulation disorders, heart conditions, immunosuppressive treatments, and pregnancy are discussed.
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Bertozzi N, Pesce M, Santi P, Raposio E. One-Stage Immediate Breast Reconstruction: A Concise Review. BIOMED RESEARCH INTERNATIONAL 2017; 2017:6486859. [PMID: 29098159 PMCID: PMC5643043 DOI: 10.1155/2017/6486859] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 08/24/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND One-stage direct-to-implant immediate breast reconstruction (IBR) is performed simultaneously with breast cancer resection. We explored indications, techniques, and outcomes of IBR to determine its feasibility, safety, and effectiveness. MATERIAL AND METHODS We reviewed the available literature on one-stage direct-to-implant IBR, with or without acellular dermal matrix (ADM), synthetic mesh, or autologous fat grafting. We analyzed the indications, preoperative work-up, surgical technique, postoperative care, outcomes, and complications. RESULTS IBR is indicated for small-to-medium nonptotic breasts and contraindicated in patients who require or have undergone radiotherapy, due to unacceptably high complications rates. Only patients with thick, well-vascularized mastectomy flaps are IBR candidates. Expandable implants should be used for ptotic breasts, while anatomical shaped implants should be used to reconstruct small-to-medium nonptotic breasts. ADMs can be used to cover the implant during IBR and avoid muscle elevation, thereby minimizing postoperative pain. Flap necrosis, reoperation, and implant loss are more common with IBR than conventional two-staged reconstruction, but IBR has advantages such as lack of secondary surgery, faster recovery, and better quality of life. CONCLUSIONS IBR has good outcomes and patient-satisfaction rates. With ADM use, a shift from conventional reconstruction to IBR has occurred. Drawbacks of IBR can be overcome by careful patient selection.
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Affiliation(s)
- Nicolò Bertozzi
- Department of Medicine and Surgery, Plastic Surgery Division, University of Parma, Parma, Italy
- Cutaneous, Mini-Invasive, Regenerative and Plastic Surgery Unit, Parma University Hospital, Parma, Italy
| | - Marianna Pesce
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
- Plastic Surgery Department, IRCCS San Martino University Hospital, National Institute for Cancer Research Genoa, Genoa, Italy
| | - Pierluigi Santi
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
- Plastic Surgery Department, IRCCS San Martino University Hospital, National Institute for Cancer Research Genoa, Genoa, Italy
| | - Edoardo Raposio
- Department of Medicine and Surgery, Plastic Surgery Division, University of Parma, Parma, Italy
- Cutaneous, Mini-Invasive, Regenerative and Plastic Surgery Unit, Parma University Hospital, Parma, Italy
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Two-Blade Guillotine Technique for Nipple Graft Harvest. Arch Plast Surg 2017; 44:449-452. [PMID: 28946729 PMCID: PMC5621819 DOI: 10.5999/aps.2017.44.5.449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 03/13/2017] [Accepted: 03/28/2017] [Indexed: 11/28/2022] Open
Abstract
The nipple-sharing technique for nipple reconstruction offers excellent tissue matching. The method used for nipple graft harvesting determines the quality of the graft and hence, the success of nipple sharing. Here, we described a guillotine technique wherein the nipple is first transfixed with 2 straight needles to stabilise it. Two No. 11 blades are then inserted in the center and simultaneously swept outwards to amputate the distal portion of the nipple. This technique provides good control, resulting in a very evenly cut base. The recipient bed is deepithelialized thinly, and the nipple graft is inset with interrupted 8-0 nylon sutures under magnification. Being a composite graft, it is protected with splint dressings for 6 weeks, and the dressing is regularly changed by the surgeon. The height of the nipple grafts ranges from 4 to 8 mm. This technique was performed in 9 patients with an average follow-up of 2.9 years (range, 1–4.5 years). Apposition between the nipple graft and its bed is crucial for the success of this technique. When correctly applied, we observed rapid revascularization of the graft.
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Filobbos G, Hamnett N, Hardwicke J, Skillman J. Immediate nipple reconstruction in combination with implant reconstruction using dermal sling. Breast J 2017; 23:723-725. [PMID: 28892228 DOI: 10.1111/tbj.12904] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 12/04/2016] [Accepted: 12/05/2016] [Indexed: 11/28/2022]
Abstract
The inferior de-epithelialized dermal flap with implant is increasingly used for immediate breast reconstruction. We have adapted the technique to provide concurrent immediate nipple reconstruction by recruiting the triangle of skin above the excised nipple as a modified C-V flap. The safety and efficacy of this technique has been assessed in 15 patients, of which eight were bilateral and seven were unilateral cases. We suggest that this is a safe, reliable, and original technique for immediate nipple reconstruction in patients undergoing immediate breast reconstruction with an inferior dermal sling and implant.
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Affiliation(s)
- George Filobbos
- Department of Plastic Surgery, University Hospitals of Coventry and Warwickshire, Coventry, UK
| | - Nathan Hamnett
- Department of Plastic Surgery, University Hospitals of Coventry and Warwickshire, Coventry, UK
| | - Joseph Hardwicke
- Department of Plastic Surgery, University Hospitals of Coventry and Warwickshire, Coventry, UK.,Warwick Medical School, University of Warwick, Coventry, UK
| | - Joanna Skillman
- Department of Plastic Surgery, University Hospitals of Coventry and Warwickshire, Coventry, UK
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Bertozzi N, Pesce M, Santi P, Raposio E. Tissue expansion for breast reconstruction: Methods and techniques. Ann Med Surg (Lond) 2017; 21:34-44. [PMID: 28765784 PMCID: PMC5526469 DOI: 10.1016/j.amsu.2017.07.048] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 07/18/2017] [Accepted: 07/18/2017] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE In this work, the authors review recent data on the different methods and techniques of TE/implant-based reconstruction to determine the complication profiles and the advantages and disadvantages of the different techniques. This information will be valuable for surgeons performing breast reconstructions. MATERIALS AND METHODS A thorough literature review was conducted by the authors concerning the current strategy of tissue expander (TE)/implant-based breast reconstruction following breast cancer surgery. RESULTS Loss of the breast can strongly affect a woman's personal and social life while breast reconstruction reduces the sense of mutilation felt by women after a mastectomy, and provides psychosocial as well as aesthetic benefits. TE/implant-based reconstruction is the most common breast reconstructive strategy, constituting almost 65% of all breast reconstructions in the US. Although numerous studies have been published on various aspects of alloplastic breast reconstructions, most studies are single-center observations. No evidence-based guidelines are available as yet. Conventional TE/implant-based reconstruction can be performed as a two-stage procedure either in the immediate or delayed setting. Moreover, the adjunctive use of acellular dermal matrix further broadened the alloplastic breast reconstruction indication and also enhanced aesthetic outcomes. CONCLUSIONS TE/implant-based reconstruction has proved to be a safe, cost-effective, and reliable technique that can be performed in women with various comorbidities. Short operative time, fast recovery, and absence of donor site morbidity are other advantages over autologous breast reconstruction.
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Affiliation(s)
- Nicolò Bertozzi
- Department of Medicine and Surgery, Plastic Surgery Division, University of Parma, Cutaneous, Mini-invasive, Regenerative and Plastic Surgery Unit, Parma University Hospital, Parma, Italy
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Plastic Surgery Department, IRCCS San Martino University Hospital, National Institute for Cancer Research, Genoa, Italy
| | - Marianna Pesce
- Department of Plastic and Reconstructive Surgery, San Martino-IST University of Genova, Genova, Italy
| | - PierLuigi Santi
- Department of Plastic and Reconstructive Surgery, San Martino-IST University of Genova, Genova, Italy
| | - Edoardo Raposio
- Department of Medicine and Surgery, Plastic Surgery Division, University of Parma, Cutaneous, Mini-invasive, Regenerative and Plastic Surgery Unit, Parma University Hospital, Parma, Italy
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Plastic Surgery Department, IRCCS San Martino University Hospital, National Institute for Cancer Research, Genoa, Italy
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Bramhall RJ, Thiruchelvam PTR, Concepcion M, Gui GP. Use of acellular dermal matrix (ADM) in nipple reconstruction: the 'central-pillar technique'. Gland Surg 2017; 6:394-398. [PMID: 28861381 DOI: 10.21037/gs.2017.03.13] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Nipple reconstructions are prone to a variable and unpredictable degree of flattening, which in some cases lead to secondary reconstruction. The use of an acellular dermal matrix (ADM) augmentation may be appropriate in cases with very thin dermis that are particularly prone to flattening or in revision cases where the first procedure has already failed. The authors present a series of 13 nipple reconstructions in ten cases. Average projection at 12 months was 51% in primary cases and 46% in secondary revision cases. This represents a better than expected long term result in a difficult cohort of patients.
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Affiliation(s)
| | | | | | - Gerald P Gui
- Department of Breast Surgery, Royal Marsden Hospital, London, UK
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Zoghbi Y, Borsting EA, Chim JH, Panthaki ZJ. Smoking as a risk factor for wound dehiscence in nipple reconstruction: An analysis of 1683 cases. Breast J 2017; 24:99-100. [PMID: 28608605 DOI: 10.1111/tbj.12844] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Yasmina Zoghbi
- DeWitt Daughtry Family Department of Surgery, Division of Plastic, Aesthetic and Reconstructive Surgery, Leonard M. Miller School of Medicine University of Miami, Miami, FL, USA
| | - Emily A Borsting
- DeWitt Daughtry Family Department of Surgery, Division of Plastic, Aesthetic and Reconstructive Surgery, Leonard M. Miller School of Medicine University of Miami, Miami, FL, USA
| | - Jimmy H Chim
- DeWitt Daughtry Family Department of Surgery, Division of Plastic, Aesthetic and Reconstructive Surgery, Leonard M. Miller School of Medicine University of Miami, Miami, FL, USA
| | - Zubin J Panthaki
- DeWitt Daughtry Family Department of Surgery, Division of Plastic, Aesthetic and Reconstructive Surgery, Leonard M. Miller School of Medicine University of Miami, Miami, FL, USA
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Boulart L, Mimoun M, Noel W, Malca N, Chaouat M, Boccara D. Dealing with tattoos in plastic surgery. Complications and medical use. ANN CHIR PLAST ESTH 2017; 62:e23-e29. [DOI: 10.1016/j.anplas.2016.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 09/08/2016] [Indexed: 10/20/2022]
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Feng S, Zhang B, Kappos EA, Tremp M, Yang C. Modified S-Flap for Nipple Reconstruction. Aesthetic Plast Surg 2017; 41:312-317. [PMID: 28233130 DOI: 10.1007/s00266-017-0789-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Accepted: 01/05/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Nipple reconstruction is an important last step in the process of autologous or implant-based breast reconstruction. A multitude of techniques have been described, among others the S-flap. To prevent nipple retraction after surgery, we modified the originally described method by Cronin. METHODS By adding an S-shaped incision line, the flap can be transposed with less tension and sutured on top of the new nipple along a curved line. Furthermore, two small triangular flaps were inserted at the base for reinforcement and reduced linear contraction. Assessment was completed by measuring nipple diameter and projection with a caliper. RESULTS A total of 16 patients underwent the technique, of whom 11 could be followed after 3 and 6 months. Overall patient satisfaction with the aesthetic result was high, and we observed no infection or necrosis. Nipples were stable in size and shape at 6 months. Although reduction of 68% in projection and 31% in diameter was observed, the nipples remained pleasantly similar to the contralateral non-operated side. CONCLUSIONS The modified S-flap is a simple and reliable technique for moderate-sized nipple reconstruction. By providing more tissue at the base, size and projection remain stable and durable. Moreover, by a modified linear incision line at the base, tension and subsequent scar contraction is minimal. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Tremp M, di Summa PG, Schaakxs D, Oranges CM, Wettstein R, Kalbermatten DF. Nipple Reconstruction After Autologous or Expander Breast Reconstruction: A Multimodal and 3-Dimensional Analysis. Aesthet Surg J 2017; 37:179-187. [PMID: 27986753 DOI: 10.1093/asj/sjw181] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Little is known about the influence of the underlying tissue as donor for nipple-areola complex (NAC) reconstruction. Also, there is a complete lack of knowledge about the fate of nipple volume. OBJECTIVES The goal of this retrospective, single-institution study was to analyze a case series after nipple reconstruction using a multimodal evaluation including 3-dimensional (3D) laser scanner analyses. METHODS Unilateral mastectomy patients after either expander-based or autologous breast reconstruction using the skate flap were included. NAC caliper measurement of nipple and areola size was performed. 3D laser scanner analysis (Minolta Vivid 900) was used to calculate nipple volume, measurement of nipple, and areolar projection and diameter. Sensitivity was evaluated using the Semmes Weinstein test and patient satisfaction by a visual analog scale (VAS 1-10). RESULTS A total of 10 patients were included in the expander group and 12 patients were included in the flap group. After a median follow-up period of 32 months in the expander group and 34 months in the flap group, non-contact 3D laser surface scanning revealed a difference in projection of 55 to 60% compared to the contralateral side. The contraction in all 3 dimensions led to a dramatic difference in nipple volume with 12 ± 8% (flap reconstructions) and 12 ± 7% (expander reconstructions). Sensitivity of the areola showed better values after expander-based reconstruction. Despite the significant discrepancy in nipple volume and projection as well as areolar diameter, overall patient satisfaction was acceptable (VAS 4.1 ± 3.5). CONCLUSIONS Volume assessment revealed a massive asymmetry to the intact nipple but not between expander and flap reconstructions. Although asymmetry of the areola and nipple remains, patient satisfaction is acceptable. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Mathias Tremp
- Dr Tremp is a Plastic Surgeon and Attending, Dr Oranges is a Plastic Surgeon and PhD candidate, Dr Wettstein is a Plastic Surgeon and Consultant, and Prof Kalbermatten is a Plastic Surgeon and Medical Director at the Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland. Dr di Summa is a Plastic Surgeon and Attending, and Dr Schaakxs is a Resident, Division of Plastic, Reconstructive, and Aesthetic Surgery, CHUV, University Hospital of Lausanne, Lausanne, Switzerland
| | - Pietro G di Summa
- Dr Tremp is a Plastic Surgeon and Attending, Dr Oranges is a Plastic Surgeon and PhD candidate, Dr Wettstein is a Plastic Surgeon and Consultant, and Prof Kalbermatten is a Plastic Surgeon and Medical Director at the Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland. Dr di Summa is a Plastic Surgeon and Attending, and Dr Schaakxs is a Resident, Division of Plastic, Reconstructive, and Aesthetic Surgery, CHUV, University Hospital of Lausanne, Lausanne, Switzerland
| | - Dominique Schaakxs
- Dr Tremp is a Plastic Surgeon and Attending, Dr Oranges is a Plastic Surgeon and PhD candidate, Dr Wettstein is a Plastic Surgeon and Consultant, and Prof Kalbermatten is a Plastic Surgeon and Medical Director at the Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland. Dr di Summa is a Plastic Surgeon and Attending, and Dr Schaakxs is a Resident, Division of Plastic, Reconstructive, and Aesthetic Surgery, CHUV, University Hospital of Lausanne, Lausanne, Switzerland
| | - Carlo M Oranges
- Dr Tremp is a Plastic Surgeon and Attending, Dr Oranges is a Plastic Surgeon and PhD candidate, Dr Wettstein is a Plastic Surgeon and Consultant, and Prof Kalbermatten is a Plastic Surgeon and Medical Director at the Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland. Dr di Summa is a Plastic Surgeon and Attending, and Dr Schaakxs is a Resident, Division of Plastic, Reconstructive, and Aesthetic Surgery, CHUV, University Hospital of Lausanne, Lausanne, Switzerland
| | - Reto Wettstein
- Dr Tremp is a Plastic Surgeon and Attending, Dr Oranges is a Plastic Surgeon and PhD candidate, Dr Wettstein is a Plastic Surgeon and Consultant, and Prof Kalbermatten is a Plastic Surgeon and Medical Director at the Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland. Dr di Summa is a Plastic Surgeon and Attending, and Dr Schaakxs is a Resident, Division of Plastic, Reconstructive, and Aesthetic Surgery, CHUV, University Hospital of Lausanne, Lausanne, Switzerland
| | - Daniel F Kalbermatten
- Dr Tremp is a Plastic Surgeon and Attending, Dr Oranges is a Plastic Surgeon and PhD candidate, Dr Wettstein is a Plastic Surgeon and Consultant, and Prof Kalbermatten is a Plastic Surgeon and Medical Director at the Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland. Dr di Summa is a Plastic Surgeon and Attending, and Dr Schaakxs is a Resident, Division of Plastic, Reconstructive, and Aesthetic Surgery, CHUV, University Hospital of Lausanne, Lausanne, Switzerland.
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Kristoffersen CM, Seland H, Hansson E. A systematic review of risks and benefits with nipple-areola-reconstruction. J Plast Surg Hand Surg 2016; 51:287-295. [PMID: 27885878 DOI: 10.1080/2000656x.2016.1251935] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Most women who have their breast reconstructed are offered NAC reconstruction. Nonetheless, it is unclear what scientific evidence there is for the procedure. The aims of the present systematic review were to evaluate the quality of evidence for benefits and risks with NAC reconstruction, and to examine the evidence for different techniques. METHODS Relevant databases were searched. Inclusion criteria were controlled studies comprising ≥20 patients and a case series of ≥50 patients. Included articles had to meet criteria defined in a PICO (Patient, Intervention, Comparison, and Outcome). Data extraction and collection were performed according to the QUADAS tool. The level of evidence of the selected articles was assessed according to the Oxford Centre for Evidence-Based Medicine 2009 guidelines, and total evidence for the different research questions was graded according to the GRADE-system. RESULTS A total of 362 abstracts were retrieved following the search. Of these 325 did not meet the inclusion criteria and were excluded, leaving 37 studies to be included in the review. Among these, 36 were case series and one a small randomised non-blinded study Conclusions: The existing quality of evidence for risks and benefits of the operation is very low. It is unclear what the complication frequencies are after the reconstruction, and what effect on quality-of-life the operation has. Prospective studies of high quality are needed to evaluate the health effects and risks with NAC reconstruction.
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Affiliation(s)
| | - Håvard Seland
- a Department of Plastic and Reconstructive Surgery , Haukeland University Hospital , Bergen , Norway
| | - Emma Hansson
- b Department of Plastic and Reconstructive Surgery , Sahlgrenska University Hospital , Gothenburg , Sweden.,c Department of Clinical Sciences, Malmö, Lund University , Lund , Sweden
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Rolph R, Mehta S, Farhadi J. Breast reconstruction: options post-mastectomy. Br J Hosp Med (Lond) 2016; 77:334-42. [DOI: 10.12968/hmed.2016.77.6.334] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- R Rolph
- Honorary Clinical Research Fellow and Registrar in the Department of Plastic and Reconstructive Surgery, Guy's and St Thomas' Hospital, London SE1 7EH
| | - S Mehta
- Honorary Clinical Research Fellow and Registrar in the Department of Plastic and Reconstructive Surgery, Guy's and St Thomas' Hospital, London
| | - J Farhadi
- Clinical Lead and Consultant Plastic Surgeon in the Department of Plastic and Reconstructive Surgery, Guy's and St Thomas' Hospital, London
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Nagura-Inomata N, Iwahira Y, Hayashi N, Komiya T, Takahashi O. The optimal reconstruction size of nipple-areola complex following breast implant in breast cancer patients. SPRINGERPLUS 2016; 5:579. [PMID: 27247876 PMCID: PMC4864729 DOI: 10.1186/s40064-016-2230-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 04/25/2016] [Indexed: 11/11/2022]
Abstract
Background Changes in the areola size after reconstruction of the nipple-areola complex (NAC) following mastectomy and breast reconstruction with a silicon implant in primary breast cancer patients have not been well examined. This study aimed to investigate time-dependent changes in the size of the donor and graft NACs and to assess clinical factors influencing these changes. Methods Fifty-eight consecutive patients who underwent nipple-areola reconstruction were retrospectively evaluated. Nipple-areola diameter was measured immediately after the NAC reconstruction and at each follow-up visit for at least 36 months. Results The donor NAC constituted 81 % of the graft NAC at the time of operation. The size of the donor NAC gradually increased by up to 36.8 % after the operation. The size of the graft NAC showed a decrease by 4.5 % at 7 months, followed by recovery to the initial value. The ratio of the donor site size to the graft site size was increased at month 1 and then showed a gradual decrease to 1.08 at 36 months. A history of mastopexy or reduction for the donor site was independent factors associated with changes in the NAC size. Conclusions To achieve symmetry, the diameter of the donor NAC immediately after the reconstruction should be at least 20 % smaller than that of the graft NAC, especially for patients without a history of additional operations.
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Affiliation(s)
- Naomi Nagura-Inomata
- Department of Breast Surgical Oncology, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560 Japan
| | - Yoshiko Iwahira
- Department of Breast Surgical Oncology, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560 Japan ; Breast Surgery Clinic, YCC Takanawa Bild., 2,3/F Takanawa, Minato-ku, Tokyo, 108-0074 Japan
| | - Naoki Hayashi
- Department of Breast Surgical Oncology, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560 Japan
| | - Takako Komiya
- Breast Surgery Clinic, YCC Takanawa Bild., 2,3/F Takanawa, Minato-ku, Tokyo, 108-0074 Japan
| | - Osamu Takahashi
- Center for Clinical Epidemiology, St. Luke's Life Science Institute, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560 Japan
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Otte M, Nestle-Krämling C, Fertsch S, Hagouan M, Munder B, Richrath P, Stambera P, Abu-Ghazaleh A, Andree C. Conservative mastectomies and Immediate-DElayed AutoLogous (IDEAL) breast reconstruction: the DIEP flap. Gland Surg 2016; 5:24-31. [PMID: 26855905 DOI: 10.3978/j.issn.2227-684x.2015.05.15] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND With the development of conservative mastectomies, there are an increasing number of women seeking immediate implant based and autologous breast reconstruction. Despite the oncologic safety of the procedures, the focus will be on the timing of reconstruction. METHODS Our plastic surgery unit is focused primarily on autologous breast reconstruction and is part of an interdisciplinary breast center. We offer immediate breast reconstruction (IBR) with autologous tissue for patients with positive BRCA 1 and 2, ductal carcinoma in situ (DCIS), invasive cancer without margin problems to the skin, as well as to correct poor oncologic and aesthetic breast conserving therapy (BCT) outcomes. In the majority of cases we prefer an Immediate-DElayed AutoLogous (IDEAL) breast reconstruction concept with a two-stage procedure. RESULTS Over the last 10 years we performed more than 1,600 breast reconstructions with free flaps, performing the deep inferior epigastric perforator (DIEP) flap as our first choice for autologous tissue. We recommend IDEAL breast reconstruction, however approximately 15% of our cases are immediate one stage conservative mastectomies and breast reconstruction with the DIEP flap. CONCLUSIONS For immediate reconstruction, the aesthetic outcome should not take precedence over oncologic considerations. Immediate one-stage, breast reconstruction with autologous tissue can be offered to the suitable patients which is most likely a healthy women with a small-to-medium sized non ptotic breast receiving a conservative mastectomy. In all other cases, we recommend an IDEAL breast reconstruction approach in order to achieve a final result that is both satisfyingly pleasing and oncologically safe.
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Affiliation(s)
- Maximilian Otte
- 1 Department of Plastic and Aesthetic Surgery, 2 Department of Senology, Sana Kliniken Düsseldorf, Düsseldorf, Germany
| | - Carolin Nestle-Krämling
- 1 Department of Plastic and Aesthetic Surgery, 2 Department of Senology, Sana Kliniken Düsseldorf, Düsseldorf, Germany
| | - Sonia Fertsch
- 1 Department of Plastic and Aesthetic Surgery, 2 Department of Senology, Sana Kliniken Düsseldorf, Düsseldorf, Germany
| | - Mazen Hagouan
- 1 Department of Plastic and Aesthetic Surgery, 2 Department of Senology, Sana Kliniken Düsseldorf, Düsseldorf, Germany
| | - Beatrix Munder
- 1 Department of Plastic and Aesthetic Surgery, 2 Department of Senology, Sana Kliniken Düsseldorf, Düsseldorf, Germany
| | - Philip Richrath
- 1 Department of Plastic and Aesthetic Surgery, 2 Department of Senology, Sana Kliniken Düsseldorf, Düsseldorf, Germany
| | - Peter Stambera
- 1 Department of Plastic and Aesthetic Surgery, 2 Department of Senology, Sana Kliniken Düsseldorf, Düsseldorf, Germany
| | - Alina Abu-Ghazaleh
- 1 Department of Plastic and Aesthetic Surgery, 2 Department of Senology, Sana Kliniken Düsseldorf, Düsseldorf, Germany
| | - Christoph Andree
- 1 Department of Plastic and Aesthetic Surgery, 2 Department of Senology, Sana Kliniken Düsseldorf, Düsseldorf, Germany
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He J, Wang T, Xu H, Zhang Y, Dong J. Immediate two-stage nipple reconstruction with a local mastectomy flap following secondary autologous breast reconstruction. J Plast Reconstr Aesthet Surg 2016; 69:206-10. [DOI: 10.1016/j.bjps.2015.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 10/03/2015] [Accepted: 10/05/2015] [Indexed: 11/25/2022]
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Rem K, Al Hindi A, Sorin T, Ozil C, Revol M, Mazouz Dorval S. Nipple reconstruction after implant-based breast reconstruction in radiated patients: A new safe dermal flap. J Plast Reconstr Aesthet Surg 2016; 69:617-22. [PMID: 26810406 DOI: 10.1016/j.bjps.2015.12.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 12/29/2015] [Accepted: 12/31/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION After implant-based breast reconstruction, the nipple reconstruction technique must be carefully chosen, especially in patients with a history of radiotherapy. When the contralateral nipple is not available, using a classical dermal-fat local flap may lead to the implant exposure, and consequently, removal. We describe here a simple nipple reconstruction technique, using a strictly dermal local flap and evaluate its complication rate. PATIENTS AND METHODS All patients who underwent our technique for nipple reconstruction between January 2012 and April 2015 were included in this retrospective study. We described our surgical technique and noted the occurrence of postoperative complications. RESULTS Forty-nine nipples, in 47 patients with a history of radiotherapy, were reconstructed with our technique. The mean age was 53 years old (range 27-78 years old). The average time between radiotherapy and nipple reconstruction was 42.5 months (range from 4.6 to 274.8 months). The mean follow-up was 30.9 months (range from 6 to 47 months). No implant exposure occurred. Regarding the nipple flap, two partial flap loss and one infection occurred, the whole complication rate was 6.1%. Regarding nipple projection, it was quite low (between 2 and 5 mm) after 6 months, but remained stable. CONCLUSION Our strictly dermal local flap technique for nipple reconstruction is a safe procedure and represents a good alternative to composite contralateral nipple graft in irradiated patients with an implant-based reconstructed breast.
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Affiliation(s)
- K Rem
- Plastic, Reconstructive and Aesthetic Surgery Department, AP-HP, Hôpital Saint-Louis, F-75010 Paris, France.
| | - A Al Hindi
- Plastic, Reconstructive and Aesthetic Surgery Department, AP-HP, Hôpital Saint-Louis, F-75010 Paris, France
| | - T Sorin
- Plastic, Reconstructive and Aesthetic Surgery Department, AP-HP, Hôpital Saint-Louis, F-75010 Paris, France
| | - C Ozil
- Paris Diderot University, Sorbonne Paris Cité, 75010 Paris, France; Plastic, Reconstructive and Aesthetic Surgery Department, AP-HP, Hôpital Saint-Louis, F-75010 Paris, France
| | - M Revol
- Paris Diderot University, Sorbonne Paris Cité, 75010 Paris, France; Plastic, Reconstructive and Aesthetic Surgery Department, AP-HP, Hôpital Saint-Louis, F-75010 Paris, France
| | - S Mazouz Dorval
- Paris Diderot University, Sorbonne Paris Cité, 75010 Paris, France; Plastic, Reconstructive and Aesthetic Surgery Department, AP-HP, Hôpital Saint-Louis, F-75010 Paris, France
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Choi WC, Choi HG, Kim JN, Lee MC, Shin DH, Kim SH, Kim CK, Jo DI. Nipple Reconstruction Using a Scar-Based Modified C-V Flap. ARCHIVES OF AESTHETIC PLASTIC SURGERY 2016. [DOI: 10.14730/aaps.2016.22.3.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Won Chul Choi
- Department of Plastic and Reconstructive Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Hyun Gon Choi
- Department of Plastic and Reconstructive Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Jee Nam Kim
- Department of Plastic and Reconstructive Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Myung Chul Lee
- Department of Plastic and Reconstructive Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Dong Hyeok Shin
- Department of Plastic and Reconstructive Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Soon Heum Kim
- Department of Plastic and Reconstructive Surgery, Konkuk University Chungju Hospital, Konkuk University School of Medicine, Chungju, Korea
| | - Cheol Keun Kim
- Department of Plastic and Reconstructive Surgery, Konkuk University Chungju Hospital, Konkuk University School of Medicine, Chungju, Korea
| | - Dong In Jo
- Department of Plastic and Reconstructive Surgery, Konkuk University Chungju Hospital, Konkuk University School of Medicine, Chungju, Korea
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Temporary Areolar Demarcation for Nipple-areola Complex Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2015; 3:e490. [PMID: 26495203 PMCID: PMC4560223 DOI: 10.1097/gox.0000000000000461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 06/25/2015] [Indexed: 11/25/2022]
Abstract
We have described a surgical method that enhances the visual aesthetic outcome of the areola periphery in nipple-areola complex reconstruction. This technique is performed immediately following closure of the nipple flap. The created areolar outline can aid the tattoo artist and may result in a more natural-appearing areola periphery than tattooing methods alone.
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Reconstruction of Areolar Projection Using a Purse-String Suture Technique. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2015; 3:e453. [PMID: 26301142 PMCID: PMC4527627 DOI: 10.1097/gox.0000000000000431] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 05/27/2015] [Indexed: 11/26/2022]
Abstract
Background: Nipple–areolar complex creation is the last step in the breast reconstruction process and plays a significant role in patients’ overall satisfaction. Although numerous surgical techniques have been described to create the nipple, very few procedures address the natural contour of the areola. Methods: We describe a surgical technique using a purse-string suture for improved areolar projection. After creation of nipple–areolar complex using a CV flap, evenly spaced stab incisions are made in a circular pattern, approximately 5 mm outside of the boundary of the proposed areola. Using these incisions, a nonabsorbable purse-string suture is placed in the deep dermis. The diameter is cinched down to the desired measurement, providing areolar projection. Results: Our experience using this technique has provided a satisfactory and stable projection of the areola in 10 patients with at least 1 year follow-up for each patient. There was no spitting of purse-string sutures in any of these patients, and there was no late areolar widening after at least 1 year follow-up. This provides a means for symmetry with an unreconstructed contralateral side. Conclusions: Improving aesthetic outcomes for areola reconstruction may further refine our goals of an ideal breast reconstruction.
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He J, Xu H, Wang T, Qiao Y, Zhang Y, Dong J. Immediate nipple reconstruction with thoracodorsal artery perforator flap in breast reconstruction by latissimus dorsi myocutaneous flap in patients with Poland's syndrome. Microsurgery 2015; 36:49-53. [PMID: 25752505 DOI: 10.1002/micr.22395] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 12/21/2014] [Accepted: 02/16/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Jinguang He
- Department of Plastic and Reconstructive Surgery; Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai People's Republic of China
| | - Hua Xu
- Department of Plastic and Reconstructive Surgery; Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai People's Republic of China
| | - Tao Wang
- Department of Plastic and Reconstructive Surgery; Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai People's Republic of China
| | - Yufei Qiao
- Department of Plastic and Reconstructive Surgery; Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai People's Republic of China
| | - Yi Zhang
- Department of Plastic and Reconstructive Surgery; Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai People's Republic of China
| | - Jiasheng Dong
- Department of Plastic and Reconstructive Surgery; Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai People's Republic of China
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Margolis NE, Morley C, Lotfi P, Shaylor SD, Palestrant S, Moy L, Melsaether AN. Update on imaging of the postsurgical breast. Radiographics 2015; 34:642-60. [PMID: 24819786 DOI: 10.1148/rg.343135059] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Oncologic, reconstructive, and cosmetic breast surgery has evolved in the last 20 years. Familiarity with cutting-edge surgical techniques and their imaging characteristics is essential for radiologic interpretation and may help avert false-positive imaging findings. Novel surgical techniques include skin- and nipple-sparing mastectomies, autologous free flaps, autologous fat grafting, and nipple-areola-complex breast reconstruction. These techniques are illustrated and compared with conventional surgical techniques, including modified radical mastectomy and autologous pedicled flaps. The role of magnetic resonance (MR) imaging in surgical planning, evaluation for complications, and postsurgical cancer detection is described. Breast reconstruction and augmentation using silicone gel-filled implants is discussed in light of the Food and Drug Administration's recommendation for MR imaging screening for "silent" implant rupture 3 years after implantation and every 2 years thereafter. Recent developments in skin incision techniques for reduction mammoplasty are presented. The effects of postsurgical changes on the detection of breast cancer are discussed by type of surgery.
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Affiliation(s)
- Nathaniel E Margolis
- From the Department of Radiology, Breast Imaging Section, New York University School of Medicine, Langone Medical Center, 550 First Ave, New York, NY 10016
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Kasai S, Shimizu Y, Nagasao T, Ohnishi F, Minabe T, Momosawa A, Kishi K. An anatomic study of nipple position and areola size in Asian men. Aesthet Surg J 2015; 35:NP20-7. [PMID: 25717123 DOI: 10.1093/asj/sju023] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In planning gender-reassignment surgery for biological women and treating men with gynecomastia, surgeons must have a thorough understanding of anatomically correct nipple positions and appropriate areola sizes in men. OBJECTIVES The authors sought to determine whether body height or body mass index (BMI) affects nipple position or areola size in men. METHODS Anatomic measurements of the nipples and areolae of 50 Japanese men were obtained. A relative coordinate system was defined, where the medial-lateral and superior-inferior positions of the nipple were quantitatively indicated by distance ratios between anatomic landmarks. Nipple positions were evaluated for each patient by referring to this coordinate system, and the positions were compared between groups categorized by body height or BMI. RESULTS Nipple position was not significantly affected by body height. However, the nipple tended to be located more laterally in participants with higher BMI. The vertical nipple position differed between standing and supine positions. Tall men had larger areolae than short men; however, areola size did not differ with respect to BMI. CONCLUSIONS Nipple position and areola size vary by body shape. Consideration of the differences is recommended when performing procedures such as female-to-male gender-reassignment surgery or correction of gynecomastia.
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Affiliation(s)
- Shogo Kasai
- Dr Kasai is Chief Plastic Surgeon, Sano Kousei General Hospital, Tochigi, Japan. Dr Shimizu is an Assistant Professor, Dr Nagasao is an Associate Professor, and Dr Kishi is a Professor, Department of Plastic and Reconstructive Surgery, Keio University Hospital, Tokyo, Japan. Dr Ohnishi is an assistant professor and Dr Minabe is a Professor, Department of Plastic Surgery, Saitama Medical Center, Saitma Medical University, Saitama, Japan. Dr Momosawa is an Associate Professor, Department of Plastic, Reconstructive and Aesthetic Surgery, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Yusuke Shimizu
- Dr Kasai is Chief Plastic Surgeon, Sano Kousei General Hospital, Tochigi, Japan. Dr Shimizu is an Assistant Professor, Dr Nagasao is an Associate Professor, and Dr Kishi is a Professor, Department of Plastic and Reconstructive Surgery, Keio University Hospital, Tokyo, Japan. Dr Ohnishi is an assistant professor and Dr Minabe is a Professor, Department of Plastic Surgery, Saitama Medical Center, Saitma Medical University, Saitama, Japan. Dr Momosawa is an Associate Professor, Department of Plastic, Reconstructive and Aesthetic Surgery, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Tomohisa Nagasao
- Dr Kasai is Chief Plastic Surgeon, Sano Kousei General Hospital, Tochigi, Japan. Dr Shimizu is an Assistant Professor, Dr Nagasao is an Associate Professor, and Dr Kishi is a Professor, Department of Plastic and Reconstructive Surgery, Keio University Hospital, Tokyo, Japan. Dr Ohnishi is an assistant professor and Dr Minabe is a Professor, Department of Plastic Surgery, Saitama Medical Center, Saitma Medical University, Saitama, Japan. Dr Momosawa is an Associate Professor, Department of Plastic, Reconstructive and Aesthetic Surgery, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Fumio Ohnishi
- Dr Kasai is Chief Plastic Surgeon, Sano Kousei General Hospital, Tochigi, Japan. Dr Shimizu is an Assistant Professor, Dr Nagasao is an Associate Professor, and Dr Kishi is a Professor, Department of Plastic and Reconstructive Surgery, Keio University Hospital, Tokyo, Japan. Dr Ohnishi is an assistant professor and Dr Minabe is a Professor, Department of Plastic Surgery, Saitama Medical Center, Saitma Medical University, Saitama, Japan. Dr Momosawa is an Associate Professor, Department of Plastic, Reconstructive and Aesthetic Surgery, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Toshiharu Minabe
- Dr Kasai is Chief Plastic Surgeon, Sano Kousei General Hospital, Tochigi, Japan. Dr Shimizu is an Assistant Professor, Dr Nagasao is an Associate Professor, and Dr Kishi is a Professor, Department of Plastic and Reconstructive Surgery, Keio University Hospital, Tokyo, Japan. Dr Ohnishi is an assistant professor and Dr Minabe is a Professor, Department of Plastic Surgery, Saitama Medical Center, Saitma Medical University, Saitama, Japan. Dr Momosawa is an Associate Professor, Department of Plastic, Reconstructive and Aesthetic Surgery, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Akira Momosawa
- Dr Kasai is Chief Plastic Surgeon, Sano Kousei General Hospital, Tochigi, Japan. Dr Shimizu is an Assistant Professor, Dr Nagasao is an Associate Professor, and Dr Kishi is a Professor, Department of Plastic and Reconstructive Surgery, Keio University Hospital, Tokyo, Japan. Dr Ohnishi is an assistant professor and Dr Minabe is a Professor, Department of Plastic Surgery, Saitama Medical Center, Saitma Medical University, Saitama, Japan. Dr Momosawa is an Associate Professor, Department of Plastic, Reconstructive and Aesthetic Surgery, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Kazuo Kishi
- Dr Kasai is Chief Plastic Surgeon, Sano Kousei General Hospital, Tochigi, Japan. Dr Shimizu is an Assistant Professor, Dr Nagasao is an Associate Professor, and Dr Kishi is a Professor, Department of Plastic and Reconstructive Surgery, Keio University Hospital, Tokyo, Japan. Dr Ohnishi is an assistant professor and Dr Minabe is a Professor, Department of Plastic Surgery, Saitama Medical Center, Saitma Medical University, Saitama, Japan. Dr Momosawa is an Associate Professor, Department of Plastic, Reconstructive and Aesthetic Surgery, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
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Nimboriboonporn A, Chuthapisith S. Nipple-areola complex reconstruction. Gland Surg 2014; 3:35-42. [PMID: 25083492 DOI: 10.3978/j.issn.2227-684x.2014.02.06] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 02/27/2014] [Indexed: 11/14/2022]
Abstract
Nipple areolar reconstruction (NAC) was introduced since 1940s and evolved as parallel with breast reconstruction since era of breast cancer treatment. It consists of nipple and areolar reconstruction. Ideal reconstruction of the NAC requires symmetry in position, size, shape, texture, and pigmentation and permanent projection. There are many innovative ways to create a nipple and each method has its unique characteristics that apply to certain breast types. NAC reconstruction techniques comprises of composite nipple grafts, local flap, flaps with autologous graft augmentation, flaps with alloplastic augmentation and flaps with allograft augmentation. Areolar reconstruction by using skin grafting and tattooing are the easiest and most common techniques. With the evolution of techniques and technology, perhaps the newer methods of NAC reconstruction can produce promising long-lasting aesthetically acceptable result with minimal morbidity.
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Affiliation(s)
- Anongporn Nimboriboonporn
- Division of Head, Neck and Breast Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Suebwong Chuthapisith
- Division of Head, Neck and Breast Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
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Surgical Treatment of Nipple Malposition in Nipple-Sparing Mastectomy Device-Based Reconstruction. Plast Reconstr Surg 2014; 133:1053-1062. [DOI: 10.1097/prs.0000000000000094] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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