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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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Kuruvilla AS, Gopman JM, Cham S, Henderson PW. Nipple-areolar tattoo: Comprehensive review of history, theory, technique, and outcomes. J Plast Reconstr Aesthet Surg 2021; 75:544-549. [PMID: 34728157 DOI: 10.1016/j.bjps.2021.09.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 07/24/2021] [Accepted: 09/19/2021] [Indexed: 10/20/2022]
Abstract
Breast reconstruction aims to achieve a natural look and can involve manipulation or removal of the nipple-areola complex (NAC) as well. One of the final steps of the breast reconstruction process involves creation of the appearance of a new NAC, either via surgical intervention or medical tattooing. Medical tattooing involves little to no surgical intervention while still resulting in aesthetically pleasing results. This specific type of tattooing can be performed by a member of the plastic surgeon team, or a medical tattoo specialist. Integration of this method into plastic surgery practice can prove beneficial to the patient as a viable solution for aesthetically pleasing NAC recreation.
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Affiliation(s)
- Annet S Kuruvilla
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, United States
| | - Jared M Gopman
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, United States
| | - Samantha Cham
- Parascalpmicro Institute, New York, NY, United States
| | - Peter W Henderson
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, United States.
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Komiya T, Iwahira Y, Ishikawa T, Matsumura H. Long-Term Outcome of Nipple Projection Maintenance After Reconstruction with Clover Flap Technique. Aesthetic Plast Surg 2021; 45:1487-1494. [PMID: 33683384 DOI: 10.1007/s00266-021-02170-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 01/31/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Nipple reconstruction using local skin flap leaves no morbidity in the healthy nipple. However, one disadvantage of this procedure is that the projection is not often maintained. There are few reports on the rate of long-term maintenance of nipple projection. This study aimed to analyze the 5-year results of clover flap (C-F) nipple reconstruction to determine whether it can be used to maintain nipple projection for long periods and to investigate the factors involved in maintenance of nipple projection. METHODS Patients that underwent nipple-areola reconstruction using C-F after undergoing a two-stage implant-based breast reconstruction with skin-sparing mastectomy between January 2012 and December 2019 were included. The projection of the reconstructed nipple was measured annually for 5 years postoperatively, and the nipple projection maintenance rate (%) was calculated. The influence of eight factors, namely smoking, irradiation, scarred skin, flap pedicle relative to the mastectomy scar, location of the mastectomy scar, flap suturing, and flap necrosis, on nipple height were evaluated. RESULTS Overall, 275 patients were enrolled. The average maintenance rates (%) at 1-5 years after surgery were 47.1, 39.8, 36.4, 34.6, and 33.5. Creating a well-vascularized skin flap, designing the pedicle farther away from the mastectomy scar, choosing a surgical technique involving an oblique scar on the side of the nipple by wrapping the skin flaps, and including an appropriate amount of fat tissue inside the reconstructed nipple are important for nipple projection maintenance. CONCLUSION Nipples reconstructed using the C-F technique on the artificial mound achieve excellent long-term result. LEVEL OF EVIDENCE IV 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)
- Takako Komiya
- Department of Plastic and Reconstructive Surgery, Tokyo Medical University, 6-7-1 Nishishinjyuku Shinjyuku-ku, Tokyo, 160-0023, Japan.
| | | | - Takashi Ishikawa
- Department of Breast Surgery, Tokyo Medical University, Tokyo, Japan
| | - Hajime Matsumura
- Department of Plastic and Reconstructive Surgery, Tokyo Medical University, 6-7-1 Nishishinjyuku Shinjyuku-ku, Tokyo, 160-0023, Japan
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Lee JS, Eom JR, Lee JW, Choi KY, Chung HY, Cho BC, Yang JD. Safe delayed procedure of nipple reconstruction in poorly circulated nipple. Breast J 2018; 25:129-133. [PMID: 30557907 DOI: 10.1111/tbj.13167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 12/11/2017] [Accepted: 12/12/2017] [Indexed: 11/30/2022]
Abstract
Nipple-areolar complex reconstruction represents the final step in breast reconstruction. However, there is no gold standard nipple reconstruction technique that addresses the issue of blood circulation in the flap, which is the most basic complication. Nipple reconstruction was performed in 21 patients. A delayed procedure was performed when a poor outcome was expected due to marginal pinpoint bleeding in the distal tip after flap elevation during nipple reconstruction. The delayed nipple reconstruction can be viewed as a safe and reliable method for improving nipple blood circulation, reducing complications, and enabling long-term nipple projection maintenance in high-risk patients.
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Affiliation(s)
- Joon Seok Lee
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jeung Ryeol Eom
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jeong Woo Lee
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Kang Young Choi
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Ho Yun Chung
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Byung Chae Cho
- Department of Plastic and Reconstructive 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
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Quadruped and Dermal Bridge Flap for Nipple Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1872. [PMID: 30349778 PMCID: PMC6191210 DOI: 10.1097/gox.0000000000001872] [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: 03/14/2018] [Accepted: 06/01/2018] [Indexed: 11/26/2022]
Abstract
Background: This report describes the authors' novel preferred method of nipple reconstruction over 10 years. Methods: The procedure was used in 39 patients (unilateral 38, bilateral 1). The circle is designed as the new nipple cap. Then, 4 fan-shapes (one-quarter of the circle) are drawn so that the base portion is in contact with the circumference. These fanshapes are deepithelialized, and their linear portions are cut with full thickness of skin and elevated as dermal flaps. Then, the cross-type flap is elevated with sufficient subcutaneous fat. The two pairs of dermal flaps are sutured to each other on a diagonal line. Double-layer dermal bridge flaps sustain the base of the pocket. As a result, the cross flap becomes a birdcage-like tower. The rolled auricular cartilage is placed into the pocket. Results: In one early case, the cartilage was exposed. Early postoperatively, the other three cases underwent reoperation during other procedures because the reconstructed nipple was too large or too small. The projection of the flap was designed to be 7–15 mm (average, 9.3 mm). The average follow-up period was 25.7 ± 22.0 months. The reconstructed nipple projection was maintained at 4.4 ± 2.4 mm (maintenance rate, 48.4% ± 27.0%). Conclusions: All scars were contained within the periareolar region and thus could be completely camouflaged by tattooing. The perfusion of the skin flap is stable because of sufficient circulation from quadruped pedicle. The cartilage supported by the double-layered dermal bridge flaps contributes to nipple projection. We recommend it for patients seeking nipple reconstruction.
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Satake T, Muto M, Nagashima Y, Haga S, Homma Y, Nakasone R, Kadokura M, Kou S, Fujimoto H, Maegawa J. Polyurethane Foam Wound Dressing Technique for Areola Skin Graft Stabilization and Nipple Protection After Nipple-Areola Reconstruction. Aesthetic Plast Surg 2018; 42:442-446. [PMID: 29101435 DOI: 10.1007/s00266-017-1013-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 10/20/2017] [Indexed: 11/25/2022]
Abstract
We describe a new wound management technique using a soft dressing material to stabilize the areola skin graft and protect the nipple after nipple-areola reconstruction at the final stage of breast reconstruction. We introduced a center-fenestrated multilayered hydrocellular polyurethane foam dressing material that provides adequate pressure and retains a moist environment for a smooth skin graft "take." Moreover, the reconstructed nipple can be monitored at any time through the fenestrated window for adequate blood circulation. Altogether, this simple and inexpensive wound dressing technique improves the clinical outcome. 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 Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Toshihiko Satake
- Department of Plastic and Reconstructive Surgery, Yokohama City University Medical Center, 4-56 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan.
| | - Mayu Muto
- Department of Plastic and Reconstructive Surgery, Yokohama City University Medical Center, 4-56 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan
| | - Yu Nagashima
- Department of Plastic and Reconstructive Surgery, Yokohama City University Medical Center, 4-56 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan
| | - Shoko Haga
- Department of Plastic and Reconstructive Surgery, Yokohama City University Medical Center, 4-56 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan
| | - Yuki Homma
- Department of Plastic and Reconstructive Surgery, Yokohama City University Medical Center, 4-56 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan
| | - Reiko Nakasone
- Department of Plastic and Reconstructive Surgery, Yokohama City University Medical Center, 4-56 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan
| | - Marina Kadokura
- Department of Plastic and Reconstructive Surgery, Yokohama City University Medical Center, 4-56 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan
| | - Seiko Kou
- Department of Plastic and Aesthetic Surgery, KO Clinic for Antiaging, 4-54 Onoe-cho, Naka-ku, Yokohama, Kanagawa, 231-0015, Japan
| | - Hiroshi Fujimoto
- Department of General Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-0856, Japan
| | - Jiro Maegawa
- Department of Plastic and Reconstructive Surgery, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
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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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