The "Five-flap" Technique for Nipple-Areola Complex Reconstruction

Comparative Analysis of Nipple Reconstruction Techniques: Five Flap vs. C-V Flap

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.

Parecoxib decreases cellular growth and Bcl-2 protein levels in primary cultures of keloid fibroblasts

Keloids seem to overexpress cyclo-oxygenase-2 (COX-2), suggesting a role in its deregulated pathway in inducing an altered epithelial-mesenchymal interaction, which may be responsible for the overgrowth of dermal components resulting in scars or keloid lesions. This study aimed to evaluate the effect of Parecoxib, a COX-2 inhibitor, on cell growth in fibroblast primary cultures obtained from human keloid tissues. Tissue explants were obtained from patients who underwent intralesional excision of untreated keloids; central fractions were isolated from keloid tissues and used for establishing distinct primary cultures. Appropriate aliquots of Parecoxib, a COX-2 inhibitor were diluted to obtain the concentration used in the experimental protocols in vitro (1, 10 or 100 μM). Treatment with Parecoxib (at all concentrations) caused a significant decrease in cellular growth from 24 hours onwards, and with a maximum at 72 hours (P < .02). Moreover, at 72 hours Parecoxib significantly reduced cellular vitality. Parecoxib treatment also induced an increase in fragmented nuclei with a maximum effect at 100 μM and a significant decrease in Bcl-2 and an increase in activated caspase-3 protein levels at 72 hours compared with control untreated cultures. Our findings suggest a potential use of the COX-2 inhibitor, Parecoxib, as the therapy for keloids.

An Algorithm for Correction of Mild Tuberous Breast Deformity in Augmentation Mammaplasty: Camouflage or Correct?

BACKGROUND

Tuberous breast deformity (TBD) is a common abnormality, particularly in patients presenting for breast augmentation. Failure to correct each regional abnormality, including the inframammary fold, lower pole deficiency, nipple-areola complex widening or herniation, or any degree of ptosis, will result in exaggeration of the deformity and a poor aesthetic outcome.

OBJECTIVES

To describe an algorithm, including novel techniques, to address each region of mild TBD in patients undergoing breast augmentation.

METHODS

This is a retrospective review and description of the senior author's (K.T.) techniques for correction of early-stage TBD from 2016 to 2021.

RESULTS

One hundred forty-two patients underwent a stepwise approach to correct milder TBD features when undergoing breast augmentation.

CONCLUSIONS

The authors propose a regional algorithm for management of TBD, to allow mostly single-stage correction, except in cases with marked ptosis, severe asymmetry, or marked macroareola.

LEVEL OF EVIDENCE: 4

Correction of Rippling in Implant-based Breast Reconstruction with Serratus Fascia Flap

Implant-based breast reconstruction represents the most popular procedure for the treatment of women undergoing skin-sparing mastectomy. In selected patients, it allows for obtaining an excellent appearance of the reconstructed breast with great satisfaction to the patient. However, aesthetic and functional results can be affected by complications requiring reoperation. Among them, rippling is an undesired occurrence associated with implant-based reconstruction. It consists of a cutaneous manifestation, visible and/or palpable, of the implant wrinkles and edge which appear mostly when the patient leans forward. To treat this contour deformity, several techniques have been described such as acellular dermal matrices and autologous tissues. In this study, we intend to add the serratus anterior fascial flap within the autologous options in the treatment of implant rippling, reporting our experience.