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Viability of acellular biologic graft for nipple-areolar complex reconstruction in a non-human primate model. Sci Rep 2021; 11:15085. [PMID: 34301975 PMCID: PMC8302621 DOI: 10.1038/s41598-021-94155-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 07/05/2021] [Indexed: 11/09/2022] Open
Abstract
Many of the > 3.5 million breast cancer survivors in the US have undergone breast reconstruction following mastectomy. Patients report that nipple-areolar complex (NAC) reconstruction is psychologically important, yet current reconstruction techniques commonly result in inadequate shape, symmetry, and nipple projection. Our team has developed an allogeneic acellular graft for NAC reconstruction (dcl-NAC) designed to be easy to engraft, lasting, and aesthetically pleasing. Here, dcl-NAC safety and host-mediated re-cellularization was assessed in a 6-week study in rhesus macaque non-human primates (NHPs). Human-derived dcl-NACs (n = 30) were engrafted on the dorsum of two adult male NHPs with each animal's own nipples as controls (n = 4). Weight, complete blood counts, and metabolites were collected weekly. Grafts were removed at weeks 1, 3, or 6 post-engraftment for histology. The primary analysis evaluated health, re-epithelialization, and re-vascularization. Secondary analysis evaluated re-innervation. Weight, complete blood counts, and metabolites remained mostly within normal ranges. A new epidermal layer was observed to completely cover the dcl-NAC surface at week 6 (13-100% coverage, median 93.3%) with new vasculature comparable to controls at week 3 (p = 0.10). Nerves were identified in 75% of dcl-NACs (n = 9/12) at week 6. These data suggest that dcl-NAC is safe and supports host-mediated re-cellularization.
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Pashos NC, Graham DM, Burkett BJ, O'Donnell B, Sabol RA, Helm J, Martin EC, Bowles AC, Heim WM, Caronna VC, Miller KS, Grasperge B, Sullivan S, Chaffin AE, Bunnell BA. Acellular Biologic Nipple-Areolar Complex Graft: In Vivo Murine and Nonhuman Primate Host Response Evaluation. Tissue Eng Part A 2020; 26:872-885. [PMID: 31950890 DOI: 10.1089/ten.tea.2019.0222] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
There are more than 3 million breast cancer survivors living in the United States of which a significant number have undergone mastectomy followed by breast and nipple-areolar complex (NAC) reconstruction. Current strategies for NAC reconstruction are dependent on nonliving or nonpermanent techniques, including tattooing, nipple prosthetics, or surgical nipple-like structures. Described herein is a tissue engineering approach demonstrating the feasibility of an allogeneic acellular graft for nipple reconstruction. Nonhuman primate (NHP)-derived NAC tissues were decellularized and their extracellular matrix components analyzed by both proteomic and histological analyses. Decellularized NHP nipple tissue showed the removal of intact cells and greatly diminished profiles for intracellular proteins, as compared with intact NHP nipple tissue. We further evaluated the biocompatibility of decellularized grafts and their potential to support host-mediated neovascularization against commercially available acellular dermal grafts by performing in vivo studies in a murine model. A follow-up NHP pilot study evaluated the host-mediated neovascularization and re-epithelialization of onlay engrafted decellularized NAC grafts. The murine model revealed greater neovascularization in the decellularized NAC than in the commercially available control grafts, with no observed biocompatibility issues. The in vivo NHP model confirmed that the decellularized NAC grafts encourage neovascularization as well as re-epithelialization. These results support the concept that a biologically derived acellular nipple graft is a feasible approach for nipple reconstruction, supporting neovascularization in the absence of adverse systemic responses. Impact statement Currently, women in the United States most often undergo a mastectomy, followed by reconstruction, after being diagnosed with breast cancer. These breast cancer survivors are often left with nipple-areolar complex (NAC) reconstructions that are subsatisfactory, nonliving, and/or nonpermanent. Utilizing an acellular biologically derived whole NAC graft would allow these patients a living and permanent tissue engineering solution to nipple reconstruction.
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Affiliation(s)
- Nicholas C Pashos
- Center for Stem Cell Research and Regenerative Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA.,Bioinnovation PhD Program, Tulane University, School of Science and Engineering, New Orleans, Louisiana, USA.,BioAesthetics Corporation, Research Triangle Park, North Carolina, USA.,Tulane National Primate Research Center, Covington, Louisiana, USA
| | - David M Graham
- BioAesthetics Corporation, Research Triangle Park, North Carolina, USA
| | - Brian J Burkett
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ben O'Donnell
- Center for Stem Cell Research and Regenerative Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA.,Bioinnovation PhD Program, Tulane University, School of Science and Engineering, New Orleans, Louisiana, USA
| | - Rachel A Sabol
- Center for Stem Cell Research and Regenerative Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA.,Department of Pharmacology, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Joshua Helm
- Center for Stem Cell Research and Regenerative Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA.,Department of Pharmacology, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Elizabeth C Martin
- Department of Biological and Agricultural Engineering, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Annie C Bowles
- Center for Stem Cell Research and Regenerative Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - William M Heim
- BioAesthetics Corporation, Research Triangle Park, North Carolina, USA
| | - Vince C Caronna
- BioAesthetics Corporation, Research Triangle Park, North Carolina, USA
| | - Kristin S Miller
- Department of Biomedical Engineering, Tulane University, School of Science and Engineering, New Orleans, Louisiana, USA
| | - Brooke Grasperge
- Tulane National Primate Research Center, Covington, Louisiana, USA
| | - Scott Sullivan
- Center for Restorative Breast Surgery, New Orleans, Louisiana, USA
| | - Abigail E Chaffin
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Bruce A Bunnell
- Center for Stem Cell Research and Regenerative Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA.,Tulane National Primate Research Center, Covington, Louisiana, USA.,Department of Pharmacology, Tulane University School of Medicine, New Orleans, Louisiana, USA
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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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De Biasio F, Zingaretti N, Mura S, Fin A, Riccio M, Parodi PC. A new method of salvaging nipple projection after secondary nipple reconstruction using locoregional flap. Indian J Plast Surg 2017; 50:107-108. [PMID: 28615822 PMCID: PMC5469219 DOI: 10.4103/ijps.ijps_47_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Fabrizio De Biasio
- Department of Plastic and Reconstructive Surgery, University of Udine, Udine, Italy
| | - Nicola Zingaretti
- Department of Plastic and Reconstructive Surgery, University of Udine, Udine, Italy
| | - Sebastiano Mura
- Department of Plastic and Reconstructive Surgery, University of Udine, Udine, Italy
| | - Alessandra Fin
- Department of Plastic and Reconstructive Surgery, University of Udine, Udine, Italy
| | - Michele Riccio
- Department of Reconstructive Plastic Surgery-Hand Surgery, Breast Unit, AOU "Ospedali Riuniti," Ancona, Italy
| | - Pier Camillo Parodi
- Department of Plastic and Reconstructive Surgery, University of Udine, Udine, Italy
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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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Jung Y, Lee J, Lee S, Bae Y. Immediate nipple reconstruction with a C-V flap and areolar reconstruction with an autograft of the ipsilateral areola. ANZ J Surg 2016; 87:E300-E304. [PMID: 27550067 DOI: 10.1111/ans.13626] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND The authors report a new nipple-areolar complex (NAC) reconstruction technique using an autograft of the ipsilateral areola for breast cancer with nipple invasion. METHODS A total of 43 patients with breast cancer involving nipple invasion underwent oncoplastic surgery with NAC reconstruction. The nipple was reconstructed with a C-V flap, and the areola was autografted onto the new areola bed after the ipsilateral areola was confirmed to be tumour-free. The cosmetic results were self-evaluated by the patients after chemotherapy or radiotherapy according to a 4-point scoring system. RESULTS Overall satisfaction with the cosmetic result was assessed as follows: excellent (n = 14), good (n = 19), fair (n = 7) or poor (n = 3). Oncological evaluation revealed no cases of local recurrence and five cases of distant metastasis. CONCLUSION The immediate NAC reconstruction technique involving a C-V flap and autografting of the ipsilateral areola is a feasible method for obtaining realistic areolar reconstruction.
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Affiliation(s)
- Younglae Jung
- Department of Surgery, Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Jeeyeon Lee
- Department of Surgery, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Seokwon Lee
- Department of Surgery, Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Youngtae Bae
- Department of Surgery, Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
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7
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Nagura-Inomata N, Iwahira Y, Hayashi N, Komiya T, Takahashi O. The optimal reconstruction size of nipple-areola complex following breast implant in breast cancer patients. SPRINGERPLUS 2016; 5:579. [PMID: 27247876 PMCID: PMC4864729 DOI: 10.1186/s40064-016-2230-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 04/25/2016] [Indexed: 11/11/2022]
Abstract
Background Changes in the areola size after reconstruction of the nipple-areola complex (NAC) following mastectomy and breast reconstruction with a silicon implant in primary breast cancer patients have not been well examined. This study aimed to investigate time-dependent changes in the size of the donor and graft NACs and to assess clinical factors influencing these changes. Methods Fifty-eight consecutive patients who underwent nipple-areola reconstruction were retrospectively evaluated. Nipple-areola diameter was measured immediately after the NAC reconstruction and at each follow-up visit for at least 36 months. Results The donor NAC constituted 81 % of the graft NAC at the time of operation. The size of the donor NAC gradually increased by up to 36.8 % after the operation. The size of the graft NAC showed a decrease by 4.5 % at 7 months, followed by recovery to the initial value. The ratio of the donor site size to the graft site size was increased at month 1 and then showed a gradual decrease to 1.08 at 36 months. A history of mastopexy or reduction for the donor site was independent factors associated with changes in the NAC size. Conclusions To achieve symmetry, the diameter of the donor NAC immediately after the reconstruction should be at least 20 % smaller than that of the graft NAC, especially for patients without a history of additional operations.
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Affiliation(s)
- Naomi Nagura-Inomata
- Department of Breast Surgical Oncology, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560 Japan
| | - Yoshiko Iwahira
- Department of Breast Surgical Oncology, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560 Japan ; Breast Surgery Clinic, YCC Takanawa Bild., 2,3/F Takanawa, Minato-ku, Tokyo, 108-0074 Japan
| | - Naoki Hayashi
- Department of Breast Surgical Oncology, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560 Japan
| | - Takako Komiya
- Breast Surgery Clinic, YCC Takanawa Bild., 2,3/F Takanawa, Minato-ku, Tokyo, 108-0074 Japan
| | - Osamu Takahashi
- Center for Clinical Epidemiology, St. Luke's Life Science Institute, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560 Japan
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Pizzonia G, Sasso A, Rossello C. Alternative technique for nipple-areola complex reconstruction with poor skin condition. ANZ J Surg 2015; 87:E121-E124. [PMID: 25982476 DOI: 10.1111/ans.13176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Reconstruction of the nipple-areola complex (NAC) is generally the final step in breast reconstruction. NAC reconstructions are frequently complicated by scars, which are a common complication of radical surgery. Sometimes, radiotherapy further complicates these cases. METHODS Under these conditions, we present an alternative technique with a better chance of ensuring the vitality of the reconstructed NAC. We evaluated in a 35-patient group (G1) the average healing time, the subjective perception (aesthetics satisfaction), projection and diameter of the NAC as measures of the aesthetic and safety of the results compared with those of a control group 2 who underwent traditional techniques reconstruction. RESULTS We present the following results: an average post-op projection of 5 ± 2 mm in group 1 and 8 ± 2 mm in group 2; good stability over a 12-month period: lower reduction of the NAC projection (cumulative values within 2 mm) has been 80% in group 1 and 68.57% in the control group G2. A faster full recovery has been observed without post-operative complications in group 1 (11 ± 2 days) versus group 2 (14 ± 2 days) with minor complications. Other parameters were good in measures and comparable in both groups. CONCLUSION According to our data, this technique appears to ensure a good aesthetic result with acceptable stability over time. Moreover, healing process appears to be faster and less complicated in the experimental group.
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Affiliation(s)
- Giuseppe Pizzonia
- Plastic and Maxillofacial Surgery Department, ASL 2 Savonese, Ospedale "Santa Corona", Pietra Ligure, Savona, Italy
| | - Andrea Sasso
- Plastic and Maxillofacial Surgery Department, ASL 2 Savonese, Ospedale "Santa Corona", Pietra Ligure, Savona, Italy
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Pan L, Zheng W, Ye X, Chen L, Ke Y, Wan M, Tang W, Gao J, Zhang X. A novel approach of INTRABEAM intraoperative radiotherapy for nipple-sparing mastectomy with breast reconstruction. Clin Breast Cancer 2014; 14:435-41. [PMID: 24985074 DOI: 10.1016/j.clbc.2014.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2013] [Revised: 03/31/2014] [Accepted: 04/23/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Despite the advancement and increasing use of breast-conserving surgery, mastectomies, including nipple-sparing mastectomy (NSM), are still carried out in a portion of breast cancer patients. However, the role of NSM is still controversial, mainly because of concern about the oncologic safety of the nipple-areola complex (NAC). INTRABEAM (Carl Zeiss, Oberkochen, Germany) is the most widely used mobile intraoperative radiotherapy (IORT) device to date. This pilot study aims to broaden the application of the INTRABEAM system for breast cancer, investigating the feasibility of INTRABEAM IORT in NSM with breast reconstruction. PATIENTS AND METHODS From December 2012 to June 2013, 7 female patients with breast cancer were enrolled in the study. NSM with or without axillary dissection was performed first. After confirming negative retroareolar frozen section results and no poor local bleeding in the NAC, INTRABEAM IORT was carried out with a single dose of 16 Gy, followed by breast reconstruction. The complications and short-term outcomes were assessed. RESULTS The median radiation time was 13 minutes 14 seconds in the 7 cases. One patient complained of mild pain in the radiation field on the skin in the first 2 weeks. All 7 patients were followed for a median of 7 months. No acute radiation injury with symptoms (heart, lung, or hematologic system), NAC necrosis, local recurrence, or metastasis was observed. Although every patient had reduction in NAC sensitivity, the contours of the breasts (including the NAC) were satisfactory. CONCLUSIONS INTRABEAM IORT may be a feasible and convenient approach for NSM with breast reconstruction in patients with breast cancer.
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Affiliation(s)
- Lingxiao Pan
- Department of Breast Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Wenbo Zheng
- Department of Breast Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China.
| | - Xigang Ye
- Department of Breast Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Lun Chen
- Department of Breast Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Yaohua Ke
- Metabolic Bone Disease and Genetic Research Unit, Department of Osteoporosis and Bone Diseases, Shanghai Jiao Tong University, Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Minghui Wan
- Department of Radiation Oncology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Wei Tang
- Department of Breast Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Jin Gao
- Department of Breast Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Xiaoshen Zhang
- Department of Breast Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
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Friedrich OL, Heil J, Golatta M, Domschke C, Sohn C, Blumenstein M. Upper Blepharoplasty for Areola Reconstruction. Geburtshilfe Frauenheilkd 2014; 73:720-723. [PMID: 24771929 DOI: 10.1055/s-0032-1328723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Revised: 04/21/2013] [Accepted: 05/01/2013] [Indexed: 10/26/2022] Open
Abstract
Blepharoplasty is one of the most common rejuvenating facial plastic surgery procedures. The procedure has been described many times and has very few complications. The tissue removed from the upper eyelid during blepharoplasty can be used as a skin graft for areola reconstruction due to the tissue's similarity to the areola's natural skin. The present study investigated the use of upper blepharoplasty for areola reconstruction. Criteria were patient satisfaction, objective measurements and the assessment of cosmesis by a panel of physicians. All eight patients included in the study were very satisfied with the cosmetic result. Objective measurements and assessment by a panel of physicians using photographs of the reconstructed nipple-areola complex showed very good aesthetic results.
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Affiliation(s)
- O L Friedrich
- Gynäkologie und Geburtshilfe, Universitätsfrauenklinik Heidelberg, Heidelberg
| | - J Heil
- Gynäkologie und Geburtshilfe, Universitätsfrauenklinik Heidelberg, Heidelberg
| | - M Golatta
- Gynäkologie und Geburtshilfe, Universitätsfrauenklinik Heidelberg, Heidelberg
| | - C Domschke
- Gynäkologie und Geburtshilfe, Universitätsfrauenklinik Heidelberg, Heidelberg
| | - C Sohn
- Gynäkologie und Geburtshilfe, Universitätsfrauenklinik Heidelberg, Heidelberg
| | - M Blumenstein
- Gynäkologie und Geburtshilfe, Universitätsfrauenklinik Heidelberg, Heidelberg
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Pérez-Guisado J, Rodríguez-Mérida C, Rioja LF. Areola size and jugulum nipple distance after bilateral mastectomy and breast reconstruction. EPLASTY 2013; 13:e56. [PMID: 24324847 PMCID: PMC3819114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The combination of a single pedicle local flap with tattooing for complete nipple areola complex (NAC) reconstruction is currently the most supported method. Although many technical descriptions of NAC reconstruction exist in the medical literature, there are no data that define the ideal areola size (diameter of the areola) after bilateral mastectomy and breast reconstruction considering the previous areola size. METHODS This was a 3-year (2009-2012) observational, analytical, and longitudinal prospective study with 103 patients who had undergone NAC tattooing as the last process of bilateral breast reconstruction after surgery for breast cancer. Statistical differences in the areola size and the jugulum-nipple distance before mastectomy and after reconstruction were analyzed by paired Student t tests with a 95% confidence interval. RESULTS The jugulum-nipple distance before mastectomy was 4.23 cm larger than after bilateral reconstruction (mean jugulum-nipple distance: 23.89 cm vs 19.66 cm), and for that reason shorter (more cephalad). The areola size before mastectomy was 1.59 cm larger than the one chosen by the patient for reconstruction (mean diameter of the areola: 5.25 cm vs 3.65 cm). CONCLUSIONS We conclude that, after bilateral mastectomy and reconstruction, the jugulum-nipple distance is smaller and women prefer smaller areola sizes.
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Affiliation(s)
- Joaquín Pérez-Guisado
- aService of Plastic, Aesthetic and Reconstructive Surgery, Reina Sofía University Hospital,Correspondence:
| | - Consuelo Rodríguez-Mérida
- bHospital Provincial de Cordoba, Reina Sofía University Hospital, Av. Menéndez Pidal s/n 14004, Córdoba, SPAIN
| | - Luis F. Rioja
- aService of Plastic, Aesthetic and Reconstructive Surgery, Reina Sofía University Hospital
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Breast surgery under local anesthesia: second-stage implant exchange, nipple flap reconstruction, and breast augmentation. Clin Plast Surg 2013; 40:583-91. [PMID: 24093654 DOI: 10.1016/j.cps.2013.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Breast reconstruction can be performed safely with local anesthesia. Utilization of the star flap method in conjunction with tattooing successfully provides optimal aesthetic results without the need for an additional donor site. When tissue expander to silicon implant exchange is part of the operative plan, use of triple antibiotic irrigation as well as the Keller Funnel is recommended. Breast augmentation and breast augmentation-mastopexy can also be performed with good results under local anesthetic in a private operating room setting. All other operative conditions, including sterility and sound operative surgical techniques, should be the mainstay of any practice.
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One-stage nipple and breast reconstruction following areola-sparing mastectomy. Arch Plast Surg 2013; 40:553-8. [PMID: 24086809 PMCID: PMC3785589 DOI: 10.5999/aps.2013.40.5.553] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 06/25/2013] [Accepted: 07/04/2013] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Skin-sparing mastectomy with immediate breast reconstruction is increasingly becoming a proven surgical option for early-stage breast cancer patients. Areola-sparing mastectomy (ASM) has also recently become a popular procedure. The purpose of this article is to investigate the reconstructive and aesthetic issues experienced with one-stage nipple and breast reconstruction using ASM. METHODS Among the patients who underwent mastectomy between March 2008 and March 2010, 5 women with a low probability of nipple-areolar complex malignant involvement underwent ASM and immediate breast reconstruction with simultaneous nipple reconstruction using the modified C-V flap. The cosmetic outcomes of this series were reviewed by plastic surgeons and patient self-assessment and satisfaction were assessed via telephone interview. RESULTS During the average 11-month follow-up period, there were no cases of cancer recurrence, the aesthetic outcomes were graded as excellent to very good, and all of the patients were satisfied. Two patients developed a gutter-like depression around the reconstructed nipple, and one patient developed skin erosion in a small area of the areola, which healed with conservative dressing. The other complications, such as necrosis of the skin flap or areola, seroma, hematoma, or fat necrosis did not occur. CONCLUSIONS Since one-stage nipple and breast reconstruction following ASM is an oncologically safe, cost-effective, and aesthetically satisfactory procedure, it is a good surgical option for early breast cancer patients.
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