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Sue GR, Seither JG, Nguyen DH. Use of hyaluronic acid filler for enhancement of nipple projection following breast reconstruction: An easy and effective technique. JPRAS Open 2019; 23:19-25. [PMID: 32158901 PMCID: PMC7061554 DOI: 10.1016/j.jpra.2019.10.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 10/26/2019] [Indexed: 11/26/2022] Open
Abstract
Background Breast reconstruction improves the psychological well-being of patients with breast cancer. Patients who complete nipple-areolar reconstruction are even more satisfied with their final reconstructive result. Nipple flattening is a common complication. We hypothesized that injectable soft-tissue filler can be used to augment nipple projection in patients who underwent breast reconstruction. Methods This is a retrospective study of patients who underwent breast reconstruction and desired an enhanced postoperative nipple projection. The patients underwent a single session of injection with a hyaluronic acid filler as an outpatient. The filler was injected intradermally at the base of the nipple until the desired nipple projection was obtained. Results Twelve patients and 22 breasts were included in this study. Enhanced nipple projection was observed in all cases, with an average increase of 3.0 mm in nipple height (range 2.5-4.5 mm). All injected nipples remained soft to the touch. All results were stable at a median of 7.5 months follow-up. No complications were observed. Conclusions The use of injectable fillers for enhanced nipple projection is a useful adjunct treatment in patients undergoing breast reconstruction. Advantages include the ability to obtain nipple projection in patients who opt to forgo nipple-areola reconstruction with local flaps, to augment reconstructed nipples in patients with thin mastectomy skin flaps especially following implant-based reconstruction, and to improve projection of the native nipple following nipple-sparing mastectomy. Another benefit of this adjunct treatment is that the injection is reversible. Filler injection is a safe and simple solution to the problem of insufficient nipple projection.
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Affiliation(s)
- Gloria R Sue
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford Health Care, 770 Welch Road, Suite 400, Stanford, CA 94304, USA
| | - Jennifer G Seither
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford Health Care, 770 Welch Road, Suite 400, Stanford, CA 94304, USA
| | - Dung H Nguyen
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford Health Care, 770 Welch Road, Suite 400, Stanford, CA 94304, USA
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Sowa Y, Itsukage S, Sakaguchi K, Taguchi T, Numajiri T. Retention of a reconstructed nipple using a C-V flap with different layer thicknesses in the C-flap. J Plast Surg Hand Surg 2017; 52:126-129. [DOI: 10.1080/2000656x.2017.1360319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Yoshihiro Sowa
- Department of Plastic and Reconstructive Surgery, Kyoto Prefectural University of Medicine, Graduate School of Medical Sciences, Kyoto, Japan
| | - Sizu Itsukage
- Department of Plastic and Reconstructive Surgery, Kyoto Prefectural University of Medicine, Graduate School of Medical Sciences, Kyoto, Japan
| | - Kouichi Sakaguchi
- Department of Endocrine and Breast Surgery, Kyoto Prefectural University of Medicine, Graduate School of Medical Sciences, Kyoto, Japan
| | - Tetsuya Taguchi
- Department of Endocrine and Breast Surgery, Kyoto Prefectural University of Medicine, Graduate School of Medical Sciences, Kyoto, Japan
| | - Toshiaki Numajiri
- Department of Plastic and Reconstructive Surgery, Kyoto Prefectural University of Medicine, Graduate School of Medical Sciences, Kyoto, Japan
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Kim YC, Yun JY, Lee HC, Yim JH, Eom JS. Nipple reconstruction with combination of modified CV flap and contralateral nipple composite graft. J Plast Reconstr Aesthet Surg 2017; 70:243-247. [PMID: 28065406 DOI: 10.1016/j.bjps.2016.11.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 11/23/2016] [Accepted: 11/27/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Numerous nipple reconstruction methods have been proposed including the use of local flaps and composite grafts, but most methods have shown a significant loss of projection. We combined a modified CV flap with a composite graft (nipple sharing) to maximize the projection and volume of the new nipple and reduce the size of the contralateral nipple. METHODS In total, 30 patients underwent nipple reconstruction using a combined method between January 2013 and November 2015. This technique was selected if the diameter of the contralateral nipple was large and the thickness of the skin was less than 2 mm. After the modified CV flap was created, a composite graft from the contralateral nipple was placed between the V flaps and the C flap. The loss of projection and the ratio of the new nipple to the contralateral nipple were evaluated 12 months after surgery. RESULTS Nipple reconstruction was successful in all cases. The projection at 12 months after reconstruction was 68% of the initial projection, and the mean projection ratio of the new nipple to the contralateral nipple was 0.81. There was no complication in the donor nipple; in fact, the shape was improved with nipple reduction, and the scar was inconspicuous. CONCLUSIONS Nipple reconstruction that combines a modified CV flap and composite graft can maximize the nipple projection and provide a chance for nipple symmetry as the two components will act synergistically.
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Affiliation(s)
- Young Chul Kim
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Republic of Korea
| | - Ji Young Yun
- Department of Plastic and Reconstructive Surgery, Inje University Busan Paik Hospital, Republic of Korea
| | - Hyung Chul Lee
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Republic of Korea
| | - Ji Hong Yim
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Republic of Korea
| | - Jin Sup Eom
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Republic of Korea.
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Sisti A, Grimaldi L, Tassinari J, Cuomo R, Fortezza L, Bocchiotti MA, Roviello F, D'Aniello C, Nisi G. Nipple-areola complex reconstruction techniques: A literature review. Eur J Surg Oncol 2016; 42:441-65. [PMID: 26868167 DOI: 10.1016/j.ejso.2016.01.003] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 12/07/2015] [Accepted: 01/06/2016] [Indexed: 11/30/2022] Open
Abstract
Many techniques for nipple-areola complex (NAC) reconstruction are described. Clarity is required on the currently available options. Since a complete list of all the techniques described until now is not available, a possibly comprehensive literature overview was carried out from 75 papers (years 1946-2015). The local flap was the most frequently described technique for the nipple reconstruction with no significant difference in complications' rate among the various types of techniques. Complications in nipple reconstruction were 46.9% after graft, 7.9% after local flap, and 5.3% in case of flaps with autologous graft/alloplastic/allograft augmentation, while complications in areola reconstruction were 10.1% after graft, and 1.6% after areola tattoo. Flaps appear to be more reliable than grafts in nipple reconstruction, while tattoo is thought to be safer than graft in areola reconstruction. The loss of projection, although considerable (45%-75%), had not significant impact on patients' satisfaction. Due to contraction, overcorrection of 25-50% of the desired result is advisory when adopting local flaps, in order to prevent loss of projection. The use of flaps with autologous graft/alloplastic/allograft augmentation (cartilage, fat, calcium hydroxylapatite, acellular dermal matrix, polymethylmethacrylate, biologic collagen) showed a minor loss of nipple projection but may expose to a relative increased number of postoperative flap necrosis.
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Affiliation(s)
- A Sisti
- Plastic Surgery Division, General and Specialist Surgery Department, University of Siena, Siena, Italy.
| | - L Grimaldi
- Plastic Surgery Division, General and Specialist Surgery Department, University of Siena, Siena, Italy
| | - J Tassinari
- Plastic Surgery Division, General and Specialist Surgery Department, University of Siena, Siena, Italy
| | - R Cuomo
- Plastic Surgery Division, General and Specialist Surgery Department, University of Siena, Siena, Italy
| | - L Fortezza
- Plastic Surgery Division, General and Specialist Surgery Department, University of Siena, Siena, Italy
| | - M A Bocchiotti
- Department of Plastic Surgery, University of Turin, San Giovanni Battista Hospital, Turin, Italy
| | - F Roviello
- Oncologic Surgery, General and Specialist Surgery Department, University of Siena, Siena, Italy
| | - C D'Aniello
- Plastic Surgery Division, General and Specialist Surgery Department, University of Siena, Siena, Italy
| | - G Nisi
- Plastic Surgery Division, General and Specialist Surgery Department, University of Siena, Siena, Italy
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Objective and subjective evaluation of donor-site morbidity after nipple sharing for nipple areola reconstruction. J Plast Reconstr Aesthet Surg 2014; 68:168-74. [PMID: 25465146 DOI: 10.1016/j.bjps.2014.10.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 07/25/2014] [Accepted: 10/19/2014] [Indexed: 11/22/2022]
Abstract
Nipple reconstruction is of importance in achieving the best possible aesthetic outcome after breast reconstruction. Nipple sharing is a common technique; this study focused on the potential morbidity at the donor nipple. Between 2008 and 2012, 26 patients underwent nipple sharing at our institution. The donor nipple was examined before and after the procedure (mean follow-up of 21 months). Sensitivity, projection, diameter, and patient satisfaction were evaluated. The sensitivity in the donor nipple decreased, albeit insignificantly, from 1.2 g/mm2 (0.8-1.6) to 1.8 g/mm2 (0.8-4.8) (p=0.054, n=26). The projection due to graft removal decreased from 8.0 mm (6.8-10.0) to 4.5 mm (4.0-5.0) (p=0.001). Of the patients, 88% were "very satisfied" or "somewhat satisfied" with the sensitivity and 89% with the symmetry between the donor and reconstructed nipple. At least 60% of the patients were "very satisfied" with all aesthetic outcome parameters (projection, appearance, naturalness, color, and shape). All patients would agree to undergo this procedure again, if necessary. Nipple sharing was associated with minimal morbidity at the donor nipple. The postoperative projection was adequate. Regardless of whether simultaneous mastopexy was performed, the loss of sensitivity was minimal and presumably imperceptible to the patient. By using no sutures after graft removal and letting the donor nipple heal spontaneously, scarring was minimized and the natural appearance and good sensitivity of the donor nipple were preserved.
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Klinger F, Caviggioli F, Vinci V, Forcellini D, Maione L, Lisa A, Klinger M. Triple-V flap: nipple reconstruction using a modified C-V flap technique for long-lasting improvement of projection. EUROPEAN JOURNAL OF PLASTIC SURGERY 2013. [DOI: 10.1007/s00238-013-0878-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Witt P, Dujon D. The V-V flap – A simple modification of the C-V flap for nipple reconstruction. J Plast Reconstr Aesthet Surg 2013; 66:1009-10. [DOI: 10.1016/j.bjps.2013.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 03/03/2013] [Indexed: 10/26/2022]
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Kim JYS, Gust MJ, Connor CM, Davila A, Hansen NM, Nguyen KT. The weave technique for nipple reconstruction. J Plast Surg Hand Surg 2013; 47:135-8. [DOI: 10.3109/2000656x.2012.730052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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The "Swiss-Roll" flap: a modified C-V flap for nipple reconstruction. Breast 2011; 20:475-7. [PMID: 21565501 DOI: 10.1016/j.breast.2011.04.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Revised: 04/03/2011] [Accepted: 04/10/2011] [Indexed: 11/20/2022] Open
Abstract
Nipple reconstruction is an integral step in breast reconstruction. There are a variety of local-flap based techniques however one of the most commonly used is the C-V flap. The traditional flap forms a nipple shell composed of dermis and epidermis containing a core of subcutaneous fat. The shortcomings of this technique are that it relies on subcutaneous fat for nipple bulk and with time loses a significant part of its volume. We present a modification of the C-V flap designed for use in breasts with little subcutaneous fat in order to minimise post-operative nipple projection loss.
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