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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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Sinik LM, Le A, Ehirim H, Collins MS. Optimizing Aesthetic Outcomes in Autologous Breast Reconstruction: 20 Pearls for Practice. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5750. [PMID: 38633507 PMCID: PMC11023604 DOI: 10.1097/gox.0000000000005750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 02/20/2024] [Indexed: 04/19/2024]
Abstract
Autologous breast reconstruction with a deep inferior epigastric artery perforator (DIEP) flap is an excellent option for many patients proceeding with mastectomy for surgical management of their breast cancer. As microsurgical techniques and results improve and ensure consistent flap survival, optimizing aesthetic outcomes may become a primary focus. This article outlines 20 tips that can improve aesthetic results in DIEP flap breast reconstruction, based on our senior author's 8-year career in microsurgical breast reconstruction, with an emphasis on enhanced cosmesis. We highlight tips on preoperative planning, intraoperative, and revision stages of the reconstruction and provide a schematic for integrating the tips into a reader's microsurgical breast reconstruction practice.
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Affiliation(s)
- Lauren M. Sinik
- From the Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, Kans
| | - Audrey Le
- From the Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, Kans
| | - Henrietta Ehirim
- From the Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, Kans
| | - Meredith S. Collins
- From the Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, Kans
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Ferraro GA, Gesuete FP, Molle M, Cosenza V, Filosa FG, Pelella T, Nicoletti GF. Comparative Analysis of Nipple Reconstruction Techniques: Five Flap vs. C-V Flap. JPRAS Open 2024; 39:114-120. [PMID: 38204492 PMCID: PMC10776376 DOI: 10.1016/j.jpra.2023.11.014] [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: 10/09/2023] [Accepted: 11/26/2023] [Indexed: 01/12/2024] Open
Abstract
Background Nipple-areola complex reconstruction represents the final phase in the comprehensive post-mastectomy treatment regimen. Despite the diversity of approaches available, there is currently no universally accepted benchmark technique for this critical aspect of breast reconstruction. In this study, we conducted a comparative assessment of two prominent techniques, the five Flap and C-V Flap. Materials and Methods Between November 2016 and April 2023, we recruited 100 female patients who had undergone unilateral post-oncological mastectomy and divided them into two groups: Group A comprising 50 patients who underwent the 5-Flap technique, whereas Group B comprising the remaining 50 underwent the C-V Flap technique. Over a 6-month observation period, we assessed nipple projection loss and evaluated overall satisfaction through self-reporting by patients and independent assessments by a medical observer. Results In our study, none of the reconstructed nipples in Group A (5 Flap) experienced either total or partial necrosis, contrasting with Group B (C-V Flap) which encountered a 10% incidence of partial necrosis and 4% incidence of total necrosis. Furthermore, the average nipple projection loss in Group B was substantial, measuring a 30% reduction from the initial projection at the 1-year mark, whereas Group A demonstrated a significantly lower 13% reduction. Notably, despite these variations in outcomes, both groups reported an equal and high level of satisfaction, with patients and external observers providing an average satisfaction score of 8.0 and 9.0, respectively. Conclusion The five-flap technique represents a safe and effective approach for patients undergoing nipple reconstruction.
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Affiliation(s)
- Giuseppe Andrea Ferraro
- Plastic and Reconstructive Surgery Unit, Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Francesco Paolo Gesuete
- Plastic and Reconstructive Surgery Unit, Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Marcello Molle
- Plastic and Reconstructive Surgery Unit, Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Vincenzo Cosenza
- Plastic and Reconstructive Surgery Unit, Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Francesco Giuseppe Filosa
- Plastic and Reconstructive Surgery Unit, Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Tommaso Pelella
- Plastic and Reconstructive Surgery Unit, Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Giovanni Francesco Nicoletti
- Plastic and Reconstructive Surgery Unit, Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Naples, Italy
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Dong X, Shih S, Premaratne ID, Sariibrahimoglu K, Ginter P, Scott J, Limem S, Spector JA. Long-Term Maintenance of Projection of Nipples Reconstructed Using Three-Dimensionally Printed Poly-4-Hydroxybutyrate Bioabsorbable Scaffolds. Plast Reconstr Surg 2023; 152:646e-654e. [PMID: 36877752 DOI: 10.1097/prs.0000000000010384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND For patients who are unable to undergo nipple-sparing mastectomy, reconstruction of the nipple-areola complex has been shown to promote greater satisfaction in cosmetic outcome, body image, and sexual relationships. Although a variety of techniques have been developed to optimize the shape, size, and mechanical properties of the reconstructed nipple-areola complex, maintenance of sustained nipple projection over time remains a challenge for plastic surgeons. METHODS Three-dimensionally printed poly-4-hydroxybutyrate (P4HB) scaffolds were designed and fabricated filled with either mechanically minced or zested patient-derived costal cartilage, designed with an internal P4HB lattice (rebar) to provide interior structure to foster tissue ingrowth, or left unfilled. All scaffolds were wrapped within a C-V flap on the dorsa of a nude rat. RESULTS One year after implantation, neonipple projection and diameter were well preserved in all scaffolded groups compared with nonscaffolded neonipples ( P < 0.05). Histologic analysis showed significant vascularized connective tissue ingrowth at 12 months in both empty and rebar-scaffolded neonipples and fibrovascular cartilaginous tissue formation in mechanically processed costal cartilage-filled neonipples. The internal lattice promoted more rapid tissue infiltration and scaffold degradation and best mimicked the elastic modulus of the native human nipple after 1 year in vivo. No scaffolds extruded or caused any mechanical complications. CONCLUSIONS Three-dimensionally printed biodegradable P4HB scaffolds maintain diameter and projection while approximating the histologic appearance and mechanical properties of native human nipples after 1 year with a minimal complication profile. These long-term preclinical data suggest that P4HB scaffolds may be readily translated for clinical application. CLINICAL RELEVANCE STATEMENT The authors' unique, three-dimensionally printed P4HB scaffolds can be used to create custom nipple scaffolds that contour to any nipple shape and size, enabling the fabrication of tissue-engineered neonipples with significantly greater projection maintenance and closely approximating desired nipple biomechanical properties.
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Affiliation(s)
- Xue Dong
- From the Laboratory of Bioregenerative Medicine and Surgery, Department of Surgery, Division of Plastic Surgery, Weill Cornell Medical College
| | - Sabrina Shih
- From the Laboratory of Bioregenerative Medicine and Surgery, Department of Surgery, Division of Plastic Surgery, Weill Cornell Medical College
| | - Ishani D Premaratne
- From the Laboratory of Bioregenerative Medicine and Surgery, Department of Surgery, Division of Plastic Surgery, Weill Cornell Medical College
| | | | - Paula Ginter
- Pathology and Laboratory Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center
| | - Jeffrey Scott
- Tepha, Inc
- Department of Medical Science, Brown University
| | | | - Jason A Spector
- From the Laboratory of Bioregenerative Medicine and Surgery, Department of Surgery, Division of Plastic Surgery, Weill Cornell Medical College
- Nancy E. and Peter C. Meinig School of Biomedical Engineering, Cornell 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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Nisi G, Pierazzi DM, Pica Alfieri E, Cuomo R, Zerini I, Grimaldi L. Nipple reconstruction on mastectomy scar: The "double flap" technique. J Plast Reconstr Aesthet Surg 2020; 74:1101-1160. [PMID: 33189615 DOI: 10.1016/j.bjps.2020.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 09/02/2020] [Accepted: 10/12/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Giuseppe Nisi
- Division of Plastic and Reconstructive Surgery, Department of Medicine, Surgery and Neuroscience, "Santa Maria alle Scotte" Hospital, University of Siena, Viale Bracci 16, 53100 Siena, Italy
| | - Diletta Maria Pierazzi
- Division of Plastic and Reconstructive Surgery, Department of Medicine, Surgery and Neuroscience, "Santa Maria alle Scotte" Hospital, University of Siena, Viale Bracci 16, 53100 Siena, Italy
| | - Edoardo Pica Alfieri
- Division of Plastic and Reconstructive Surgery, Department of Medicine, Surgery and Neuroscience, "Santa Maria alle Scotte" Hospital, University of Siena, Viale Bracci 16, 53100 Siena, Italy.
| | - Roberto Cuomo
- Division of Plastic and Reconstructive Surgery, Department of Medicine, Surgery and Neuroscience, "Santa Maria alle Scotte" Hospital, University of Siena, Viale Bracci 16, 53100 Siena, Italy
| | - Irene Zerini
- Division of Plastic and Reconstructive Surgery, Department of Medicine, Surgery and Neuroscience, "Santa Maria alle Scotte" Hospital, University of Siena, Viale Bracci 16, 53100 Siena, Italy
| | - Luca Grimaldi
- Division of Plastic and Reconstructive Surgery, Department of Medicine, Surgery and Neuroscience, "Santa Maria alle Scotte" Hospital, University of Siena, Viale Bracci 16, 53100 Siena, Italy
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Nipple Areola Complex Reconstruction With the "Half-Dome" Technique Following Implant-Based Breast Reconstruction. Ann Plast Surg 2020; 82:614-617. [PMID: 30882413 DOI: 10.1097/sap.0000000000001797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND No single technique for nipple areola reconstruction best fits every patient and clinical scenario. Many techniques fail to provide long-term projection. One especially challenging cohort are those patients who have undergone bilateral implant-based reconstruction. We developed a modification of the C-V flap reconstruction that increases projection in the bilateral, implant-based reconstruction patient. METHODS All patients who underwent nipple areola reconstruction following implant-based breast reconstruction and who had at least a 12-month follow-up visit were identified. Nipple projection was measured and compared between the 2 groups. RESULTS Forty patients were identified. Twelve patients, 23 nipples, underwent the standard C-V flap reconstruction. Twenty-eight patients, 59 nipples, underwent the half-dome modification. Average nipple projection following the half-dome technique is more than twice that of the C-V flap. CONCLUSIONS The half-dome technique provides a useful alternative modification of the C-V flap in patients with implant-based reconstruction.
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Latissimus Dorsi Musculocutaneous Flap for Complex Breast Reconstruction: Indications, Outcomes and a Proposed Algorithm. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2382. [PMID: 31592390 PMCID: PMC6756672 DOI: 10.1097/gox.0000000000002382] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 06/14/2019] [Indexed: 11/29/2022]
Abstract
The latissimus dorsi (LD) flap is an ideal flap for salvage following failed primary breast reconstruction in the setting of radiation therapy. This study will review outcomes following secondary reconstruction with the LD flap with or without a tissue expander (TE) or implant (I).
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Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Understand how to determine nipple-areola complex positioning on the reconstructed breast. 2. Understand the multitude of local flap and distant graft options for nipple-areola complex reconstruction. 3. Draw at least three fundamental nipple-areola complex reconstruction patterns. 4. Understand the forces that are responsible for flattening of the reconstructed papule. 5. Understand the current techniques used in secondary nipple-areola complex reconstructions. SUMMARY Nipple-areola complex reconstruction and tattooing represent the final two stages of breast reconstruction. Nipple-areola complex reconstruction is typically accomplished with the use of local flaps, local flaps with augmentation grafts, or a combination thereof. Regardless of the technique used, however, all nipple-areola complex reconstructions lose a degree of projection over time. Options for secondary reconstruction include the use of local tissue flaps alone or in combination with acellular biological matrices.
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Kim H, Kim SI, Ha W, Yoon CS, Lee TJ, Kim KN. Augmentation of the Nipples Reconstructed with Modified Top-Hat Flap Using Dermal Grafts in Implant-Based Breast Reconstruction: A Comparative Study. Aesthetic Plast Surg 2017; 41:800-805. [PMID: 28175968 DOI: 10.1007/s00266-017-0806-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 01/24/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Nipple reconstruction in implant-based breast reconstruction remains challenging, as the remaining thin skin envelope results in a less projected neo-nipple with a reduced volume. This study presents a modified top-hat flap technique with rolled dermal grafts from the dog-ears of lateral wings for augmenting reconstructed nipples during implant-based breast reconstruction. METHODS Between April 2011 and December 2014, among 34 patients who underwent immediate post-mastectomy reconstruction with a direct silicone implant, nipple reconstruction was performed using the modified top-hat flap technique in only 21 patients (group A), whereas 13 patients underwent the modified top-hat flap technique with rolled dermal grafts from the dog-ears of lateral wings (group B). The projection and width of the neo-nipple were measured at the time of surgery and at 1 year post-surgery, respectively. RESULTS All modified top-hat flaps were successful without any complications. The mean nipple projections at the time of surgery were 0.75 ± 0.107 cm (range 0.5-0.9 cm) and 1.29 ± 0.064 cm (range 1.2-1.4 cm) in groups A and B, respectively (p < 0.001). The mean nipple widths at the time of surgery were 0.90 ± 0.184 cm (range 0.6-1.2 cm) and 1.43 ± 0.076 cm (range 1.3-1.5 cm) in groups A and B, respectively (p < 0.001). The maintenance of nipple projection and width was significantly increased in group B compared with group A. CONCLUSION The modified top-hat flap technique with rolled dermal grafts from the dog-ears of lateral wings is a useful and easy method to expand and augment the volume of reconstructed nipples in implant-based breast reconstruction. 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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Affiliation(s)
- Hoon Kim
- Department of Plastic and Reconstructive Surgery, Konyang University Hospital, University of Konyang College of Medicine, Myunggok Medical Research Center, Daejeon, Korea
| | - Sang Il Kim
- Department of Plastic and Reconstructive Surgery, Konyang University Hospital, University of Konyang College of Medicine, Myunggok Medical Research Center, Daejeon, Korea
| | - Won Ha
- Department of Plastic and Reconstructive Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Chi Sun Yoon
- Department of Plastic and Reconstructive Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Taik Jong Lee
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyu Nam Kim
- Department of Plastic and Reconstructive Surgery, Konyang University Hospital, University of Konyang College of Medicine, Myunggok Medical Research Center, Daejeon, Korea.
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Gooch JC, Huston T. Repair of the deflated nipple following nipple-sparing mastectomy utilizing the skate flap technique. Breast J 2017; 23:768-769. [PMID: 28397336 DOI: 10.1111/tbj.12818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Jessica C Gooch
- Division of General Surgery, Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA
| | - Tara Huston
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA
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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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Handel N, Yegiyants S. Managing Necrosis of the Nipple Areolar Complex Following Reduction Mammaplasty and Mastopexy. Clin Plast Surg 2016; 43:415-23. [DOI: 10.1016/j.cps.2015.12.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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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: 72] [Impact Index Per Article: 9.0] [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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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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Single-stage nipple-areolar complex reconstruction technique, outcomes, and patient satisfaction. Ann Plast Surg 2015; 73:492-7. [PMID: 24135688 DOI: 10.1097/sap.0b013e318276dac0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Nipple-areolar reconstruction (NAR) is the final phase of breast reconstruction and is associated with increased patient satisfaction. Nipple-areolar reconstruction is typically performed in 2 separate stages, which include nipple reconstruction and tattooing of the nipple-areolar complex (NAC). Previous studies have demonstrated that increased duration of the reconstruction is associated with decreased patient satisfaction. Because a 2-stage reconstruction prolongs the reconstructive process, we introduce a simple and novel method of single-stage NAR (SS NAR), which combines the use of local flaps for nipple reconstruction and medical tattooing of the NAC in 1 session and delivers predictable outcomes with high patient satisfaction. METHODS A retrospective chart review of patients who underwent SS NAR at our institution during the period from September 2010 to May 2012 was performed. Patient demographics, complications, outcomes, and overall patient satisfaction were assessed. A modified questionnaire (Likert scale) was used to assess patient satisfaction of nipple size, color, shape, and projection. RESULTS Twenty-nine SS NARs were performed in 18 patients: 7 unilateral and 11 bilateral. Mean age was 45 years (range, 34-60 years). No major complications were identified. Mean length of follow-up was 10 months (range, 2-22 months). A 17% complication rate was observed: 14% (4/29) had irregular dye uptake of the areola, and 3% (1/29) had dehiscence from silicone guard pressure on the incision. Two patients underwent revisions: one patient underwent additional tattooing, and the other required flap readvancement and implant downsizing secondary to the wound dehiscence. We obtained a 70% survey response rate with 100% of responders who reported that they were "very satisfied" with NAC in each dimension. CONCLUSIONS Our study demonstrates that SS NAR is a safe procedure with reproducible, excellent clinical results and very low complication rates or need for revisions. This method is cost-effective, convenient for the patient, and shortens patient recovery time with high patient satisfaction.
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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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Our Experiences in Nipple Reconstruction Using the Hammond flap. Arch Plast Surg 2014; 41:550-5. [PMID: 25276648 PMCID: PMC4179360 DOI: 10.5999/aps.2014.41.5.550] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 06/12/2014] [Accepted: 06/16/2014] [Indexed: 12/01/2022] Open
Abstract
Background Nipple reconstruction following breast mound reconstruction is the final step in breast reconstruction. Although nipple reconstruction is a simple surgery, the psychological aspects of nipple reconstruction are thought to be important. Nipple projection is a key factor in determining patient satisfaction with the surgery. In the present study, the Hammond flap technique was introduced for nipple reconstruction. Methods Twenty-six patients who had undergone breast reconstruction from February 2008 to March 2012 were enrolled in this prospective study. All patients were evaluated based on preoperative photos, and their nipple diameters and heights were measured. Postoperative evaluation was conducted 3, 6, 9, and 12 months following nipple reconstruction. A questionnaire on patient satisfaction with the nipple reconstruction was administered 12 months after nipple reconstruction. Moreover, the same plastic surgeon scored nipple projection and overall cosmetic result of the new nipple. Results The mean projection was 4.4 mm (range, 3-6 mm), and it well matched the contralateral nipple. Twelve months following nipple reconstruction, the mean reduction rate in the nipple projection was 43.6%. Patients were satisfied or very satisfied with the nipple projection and the overall cosmetic result in 80.7% cases. Conclusions In the present study, compared with other techniques, the use of the Hammond flap technique in nipple reconstruction showed competitive results with regard to nipple projection and patient satisfaction.
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Nipple reconstruction with rolled dermal graft support. Arch Plast Surg 2014; 41:158-62. [PMID: 24665425 PMCID: PMC3961614 DOI: 10.5999/aps.2014.41.2.158] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Revised: 09/13/2013] [Accepted: 10/28/2013] [Indexed: 11/23/2022] Open
Abstract
Background Loss of nipple projection is a common problem following nipple reconstruction. The aim of this study was to demonstrate that the use of a tightly rolled dermal graft is effective in the long-term maintenance of nipple projection. Methods Nipple reconstruction was performed using the C-V flap technique. A dermal graft was harvested from the dog-ear portion of previous scars. The graft was rolled tightly into a compact cylinder and used to augment the nipple reconstruction. Postoperatively, stacked Allevyn dressing was used for protecting the nipple from compression for a minimum of two months. Nipple projection was measured at the time of surgery and at 12 months postoperatively. Results Forty nipple reconstructions were performed using this technique. There were 19 transverse rectus abdominis musculocutaneous (TRAM) flaps, 10 latissimus dorsi (LD) flaps, and 11 tissue-expanded breast mounds. At one year, the mean projection was 0.80 cm (range, 0.62-1.22 cm). The twelve-month average maintenance of nipple projection was 70.2% for the TRAM flap group, 76.3% for the LD flap group, and 61.8% for the tissue-expanded group. In two patients with previous irradiation of the reconstructed breasts, relatively poor maintenance of nipple projection was noted (45.7%). No complications were noted, and all of the donor sites healed well primarily. Conclusions Our results demonstrated that the use of a C-V flap with a tightly rolled dermal graft for nipple reconstruction improves the long-term maintenance of nipple projection. Its advantages include reproducibility, technical simplicity, cost-effectiveness, and minimal donor site morbidity.
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Liodaki E, Bergmann PA, Kalousis K, Mailänder P, Siemers F. The central-pedicled intracorial skin-flap technique for reconstruction of the nipple-areola complex (NAC). Breast 2012; 22:74-7. [PMID: 22726991 DOI: 10.1016/j.breast.2012.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2011] [Revised: 04/10/2012] [Accepted: 05/24/2012] [Indexed: 11/30/2022] Open
Abstract
Nipple-areola complex (NAC) reconstruction tends to be the final phase of post-mastectomy reconstruction for many cancer patients, as it transforms the amorphous breast mound into a more aesthetically realistic breast. A variety of local-flap based techniques have been reported. In this paper we will describe a cantral-pedicled intracorial skin flap technique. Review of 12 patients showed aesthetic pleasing NAC and durable long-term results of nipple projection.
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Affiliation(s)
- Eirini Liodaki
- University Clinic of Schleswig-Holstein, Department of Plastic Surgery, Ratzeburger Alle 160, Lubeck, Germany.
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White CP, Gdalevitch P, Strazar R, Murrill W, Guay NA. Surgical tips: Areolar tattoo prior to nipple reconstruction. J Plast Reconstr Aesthet Surg 2011; 64:1724-6. [DOI: 10.1016/j.bjps.2011.06.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Revised: 06/15/2011] [Accepted: 06/21/2011] [Indexed: 11/26/2022]
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Abstract
Background: From a historical perspective, many techniques of nipple reconstruction have been performed, including a graft from the contralateral nipple, composite grafts such as toe pulp or earlobe tissue and even an intra-dermal tattoo alone. This is the final stage of breast reconstruction, and is carried out only when the surgeon is confident that acceptable symmetry and shape of the reconstructed breast has been achieved. The technical challenges of nipple reconstruction include correcting position, maintaining adequate projection and creating an inconspicuous scar. An alternative to a surgically reconstructed nipple is the use of silicone prosthetic nipples. Materials and Methods: From August 2006 until September 2007, 80 cases of nipple/areola reconstruction were performed in our department (UDINE UNIV.) following mammary reconstruction or conservative breast surgery. Forty cases were carried out with the classical technique and another 40 cases with the introduction of our modification in the form of deepithelization of a semicircular area of the adjacent skin at the base of the flap. Postoperative follow-up as regards the nipple size, site, projection, symmetry and donnar scar were assessed. Patient satisfaction was also addressed and evaluated. Results: There were good to excellent results as regards nipple size, symmetry and projection. The technique is suitable for different autologous and implant reconstruction. The technique is an outpatient procedure, is easy and is not consuming time. Areolar graft from the contra-lateral areola is colouur matching and shows nearly no deference from the opposite one. Conclusions: Simple technique and not time consuming. Maintains the consistency and projection of the new nipple. Patient satisfaction. Minimal complication.
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How long does the nipple projection last after reconstruction using the skate flap purse-string technique? Plast Reconstr Surg 2011; 127:149e-151e. [PMID: 21617432 DOI: 10.1097/prs.0b013e3182131e24] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Jankau J, Jaśkiewicz J, Ankiewicz A. A new method for using a silicone rod for permanent nipple projection after breast reconstruction procedures. Breast 2010; 20:124-8. [PMID: 21115347 DOI: 10.1016/j.breast.2010.10.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Revised: 07/19/2010] [Accepted: 10/06/2010] [Indexed: 11/25/2022] Open
Abstract
Nipple-areola complex (NAC) is a unique part of the human body. Not only is it a functional structure, but it plays an aesthetic role as well. It offers the final touch to the convex shape of the breast. Its lack frequently leads to depression in patients. This paper describes the method used by the authors for reconstructing nipple mound projection in patients following an autologous breast reconstruction procedure. To reconstruct the nipple mound an adapted local C-V flap technique described by Losken was used, with a silicone rod to support the nipple. The new method is based on simple preparation of flaps, fixing the silicone rod at the nipple bottom and below the top, it is quick and efficient in terms of time and materials used. The procedure was conducted in 30 patients: 10 cases following LDf reconstruction and Becker prosthesis or expander prosthesis, 20 cases following body tissue reconstruction with TRAM flap (Transverse Rectus Abdominis Musculocutaneous flap). All the patients who had undergone the LDf procedure developed flap necrosis followed by rod removal. In the patients who had undergone TRAM flap reconstruction no necrosis or wound split was observed, healing progressed without complications. In this group durable nipple projection was achieved. The new method for reconstructing nipple projection may be applied both in simultaneous and staged procedures, only in patients who have undergone autologous breast reconstruction procedure.
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Affiliation(s)
- Jerzy Jankau
- Department of Plastic Surgery, Medical University of Gdansk, Debinki Str 7, 80-211 Gdansk, Poland.
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Surgical outcomes and nipple projection using the modified skate flap for nipple-areolar reconstruction in a series of 422 implant reconstructions. Ann Plast Surg 2009; 62:591-5. [PMID: 19387168 DOI: 10.1097/sap.0b013e31819fb1c9] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Numerous techniques have been used in an attempt to achieve long-term nipple projection following nipple-areolar reconstruction (NAR). A common setback, however, is the diminution of projection over time; this phenomenon is particularly evident following implant based breast reconstruction. The purpose of this report was thus to evaluate surgical outcomes and long-term nipple projection with the use of "modified skate flap" technique in exclusively implant based postmastectomy reconstructions. A retrospective review was performed for the period between 1993 and 2007. All consecutive patients with 2-staged tissue expander/implant reconstructions followed by NAR using the modified skate flap technique performed by the senior author (P.C.) were identified in a prospectively maintained breast reconstruction database. Only patients with a minimum of 1-year follow-up were included in the study. Patients with a history of irradiation to the breast were excluded from nipple projection assessment. Clinical outcome measurements included long-term nipple projection as well as incidence of complications from the NAR procedure using the modified skate flap technique. Over the 15-year study period, 475 patients underwent 2-staged tissue expander/implant reconstruction followed by NAR using the modified skate flap technique. Of these, there was a total of 292 patients with the minimum requirement of 1-year follow-up post NAR (61% follow-up rate). The total number of reconstructed nipple areolar complexes evaluated in this series was 422 (130 bilateral and 162 unilateral NAR). Forty patients (28 unilateral and 12 bilateral NAR) who received radiation to their breasts were excluded from nipple projection assessment. At a median follow-up of 44 months (range: 12-84 months), mean nipple projection was 2.5 mm (range: 1-4 mm). Minor complications occurred in 7.2% of the patients (n = 292). Skin graft donor site dehiscence was the most common complication (3.1%) followed by partial skin graft nontake of the areola (2.1%). This report documents the largest series of NAR using a single technique in the setting of postmastectomy reconstructions. This technique can be safely performed over breast implants with acceptably low rates of complications and predictable results. Long-term nipple projection over implant reconstructions using this technique is modest and this must be forewarned to patients completing the final stage of their implant reconstruction.
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[Nipple-areola complex reconstruction with full-thickness skin graft and subcutaneous pedicled island flap]. ANN CHIR PLAST ESTH 2009; 54:365-9. [PMID: 19223112 DOI: 10.1016/j.anplas.2008.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2008] [Accepted: 10/15/2008] [Indexed: 11/23/2022]
Abstract
We are reporting on an easy, reliable and reproducible nipple-areola complex reconstruction. The main feature is to perform a full-thickness skin graft to rebuild the areola and a subcutaneous pedicled island flap for the reconstruction of the nipple in the middle of the graft. Each step is described. This technique remains easily practical and allows to keep an appropriate nipple projection. Moreover, it fits to all kind of breast reconstruction.
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