Abstract
Introduction
Nipple–areolar complex reconstruction is the final step of the reconstructive procedure in breast cancer patients. Nowadays, a combination of a local flap for nipple reconstruction and skin grafting or tattooing for areola reconstruction is deemed a first choice. In this paper, we are combining the techniques of local flap and full-thickness skin graft from the upper inner thigh for simultaneous reconstruction of the nipple and areola.
Patients and Methods
From January, 2016 to December, 2017, 23 female patients with an absent unilateral nipple–areolar complex due to post-oncological mastectomy and immediate implant-based breast reconstruction were subjects of the study. On an out-patient clinic basis, the percentage of the nipple projection loss was calculated at the intervals of 3 , 6 and 12 months postoperatively. At the final visit, the patient’s subjective satisfaction on the reconstructed areola compared to the normal contralateral side was evaluated using a visual analogue scale.
Results
Over the course of time, the mean nipple projection loss was 20.16 ± 12.88, 31.78 ± 11.63 and 34.69 ± 12.01% at 3 , 6 and 12 months postoperatively, respectively. Patients’ overall satisfaction on the grafted areola was as follows; the largest number of patients (8 patients) had a ‘good’ satisfaction 12-months postoperatively. Out of 21 patients, those who considered the result to be ‘poor’ and ‘disappointing’ each accounted for 1 and 3 patients.
Conclusion
The combination of nipple–areolar complex reconstruction technique introduced in this study has proven to be a safe and efficacious alternative in patients with implant-based reconstruction requiring small- to medium-sized nipple projection, especially when the skin envelope is too tight for a local flap only.
Level of Evidence IV
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References
Farhadi J, Maksvytyte GK, Schaefer DJ, Pierer G, Scheufler O (2006) Reconstruction of the nipple-areola complex: an update. J Plast Reconstr Aesthet Surg 59(1):40–53
Gougoutas AJ, Said HK, Um G, Chapin A, Mathes DW (2018) Nipple-areola complex reconstruction. Plast Reconstr Surg 141(3):404e–416e
Sisti A, Grimaldi L, Tassinari J, Cuomo R, Fortezza L, Bocchiotti MA, Nisi G (2016) Nipple-areola complex reconstruction techniques: a literature review. Eur J Surg Oncol 42(4):441–465
Few JW, Marcus JR, Casas LA, Aitken ME, Redding J (1999) Long-term predictable nipple projection following reconstruction. Plast Reconstr Surg 104(5):1321–1324
Rubino C, Dessy LA, Posadinu A (2003) A modified technique for nipple reconstruction: the ‘arrow flap’. Br J Plast Surg 56:247–251
Nahabedian MY (2007) Nipple reconstruction. Clin Plast Surg 34(1):131–137
Little JW (1984) Nipple-areola reconstruction. Clin Plast Surg 11(2):351e64
El-Ali K, Dalal M, Kat CC (2009) Modified C-V flap for nipple reconstruction: our results in 50 patients. J Plast Reconstr Aesthet Surg 62(8):991e6
Farace F, Bulla A, Puddu A et al (2010) The arrow flap for nipple reconstruction: long term results. J Plast Reconstr Aesthet Surg 63(10):e756e757
Elizabeth CS, Turton E (2014) The CC-V flap: a novel technique for augmenting a C-V nipple reconstruction using a free dermal graft. World J Plast Surg 3:8–12
Zhong T, Antony A, Cordeiro P (2009) Surgical outcomes and nipple projection using the modified skate flap for nipple-areolar reconstruction in a series of 422 implant reconstructions. Ann Plast Surg 62:591–595
Temiz G, Yeşiloğlu N, Şirinoğlu H, Sarici M (2015) A new modification of C-V flap technique in nipple reconstruction: rolled triangular dermal-fat flaps. Aesthetic Plast Surg 39:173–175
Sierakowski A, Niranjan N (2011) Star flap with a dermal platform for nipple reconstruction. J Plast Reconstr Aesthet Surg 64:e55–e56
Cuomo R, Sisti A, Grimaldi L, D’Aniello C (2016) Modified arrow flap technique for nipple reconstruction. Breast J 22:710–711
Macdonald CR, Nakhdjevani A, Shah A (2011) The, “Swiss-roll” flap: a modified C-V flap for nipple reconstruction. Breast J 20:475–477
Eo S, Kim SS, Da Lio AL (2007) Nipple reconstruction with C-V flap using dermofat graft. Ann Plast Surg 58:137–140
Mukherjee RP, Gottlieb V, Hacker L (1987) Nipple-areolar reconstruction with buried dermal hammock technique. Ann Plast Surg 19:421–423
Bosch G, Ramirez M (1984) Reconstruction of the nipple: a new technique. Plast Reconstr Surg 73:977–981
Adams WM (1949) Labial transplant for correction of loss of the nipple. Plast Reconstr Surg 4(3):295–298
Gruber RP (1977) Method to produce better areolae and nipples on reconstructed breasts. Plast Reconstr Surg 60(4):505–513
Goh SCJ, Martin NA, Pandya AN, Cutress RI (2011) Patient satisfaction following nipple-areolar complex reconstruction and tattooing. J Plast Reconstr Aesthet Surg 64(3):360–363
Nimboriboonporn A, Chuthapisith S (2014) Nipple-areola complex reconstruction. Gland Surg 3(1):35
Jalini L, Lund J, Kurup V (2017) Nipple reconstruction using the CV flap technique: long-term outcomes and patient satisfaction. World J Plast Surg 6(1):68
Winocour S, Saksena A, Oh C, Wu PS, Laungan A, Baltzer H, Saint-Cyr M (2016) A systematic review of comparison of autologous, allogeneic, and synthetic augmentation grafts in nipple reconstruction. Plast Reconstr Surg 137:14–23
Bernard RW, Beran SJ (2003) Autologous fat graft in nipple reconstruction. Plast Reconstr Surg 112:964–968
Brent B, Bostwick J (1977) Nipple-areola reconstruction with auricular tissues. Plast Reconstr Surg 60:353–361
Jones AP, Erdmann M (2012) Projection and patient satisfaction using the “Hamburger” nipple reconstruction technique. J Plast Reconstr Aesthet Surg 65:207–212
Mori H, Uemura N, Okazaki M (2015) Nipple reconstruction with banked costal cartilage after vertical-type skin-sparing mastectomy and deep inferior epigastric artery perforator flap. Breast Cancer 22:85–97
Cheng MH, Ho-Asjoe M, Wei FC, Chuang DC (2003) Nipple reconstruction in Asian females using banked cartilage graft and modified top hat flap. Br J Plast Surg 56:692–694
Chia HL, Wong M, Tan BK (2014) Nipple reconstruction with rolled dermal graft support. Arch Plast Surg 41:158–162
Guerra AB, Khoobehi K, Metzinger SE, Allen RJ (2003) New technique for nipple areola reconstruction: arrow flap and rib cartilage graft for long-lasting nipple projection. Ann Plast Surg 50:31–37
Heitland A, Markowicz M, Koellensperger E, Allen R, Pallua N (2006) Long-term nipple shrinkage following augmentation by an autologous rib cartilage transplant in free DIEP-flaps. J Plast Reconstr Aesthet Surg 59:1063–1067
Seaman BJ, Akbari SR, Davison SP (2012) A novel technique for nipple-areola complex reconstruction: the acellular dermal matrix onlay graft. Plast Reconstr Surg 129:580e–581e
Craft RO, May JW Jr (2011) Staged nipple reconstruction with vascularized SurgiMend acellular dermal matrix. Plast Reconstr Surg 127:148e–149e
Chen WF, Barounis D, Kalimuthu R (2010) A novel cost-saving approach to the use of acellular dermal matrix (AlloDerm) in postmastectomy breast and nipple reconstructions. Plast Reconstr Surg 125:479–481
Nahabedian MY (2005) Secondary nipple reconstruction using local flaps and AlloDerm. Plast Reconstr Surg 115:2056–2061
Tierney BP, Hodde JP, Changkuon DI (2014) Biologic collagen cylinder with skate flap technique for nipple reconstruction. Plast Surg Int 2014:194087
Wong RK, Wichterman L, Parson SD (2008) Skin sparing nipple reconstruction with polytetrafluoroethylene implant. Ann Plast Surg 61:256–258
Jankau J, Jaśkiewicz J, Ankiewicz A (2011) A new method for using a silicone rod for permanent nipple projection after breast reconstruction procedures. Breast 20:124–128
Garramone CE, Lam B (2007) Use of AlloDerm in primary nipple reconstruction to improve long-term nipple projection. Plast Reconstr Surg 119:1663–1668
Jalini L, Lund J, Kurup V (2016) Nipple reconstruction using the CV flap technique: long-term outcomes. Int J Surg Med 2:162–166
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Heo, JW., Park, S.O. & Jin, U.S. A Nipple–Areolar Complex Reconstruction in Implant-Based Breast Reconstruction Using a Local Flap and Full-Thickness Skin Graft. Aesth Plast Surg 42, 1478–1484 (2018). https://doi.org/10.1007/s00266-018-1162-6
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DOI: https://doi.org/10.1007/s00266-018-1162-6