Advertisement

Aesthetic Plastic Surgery

, Volume 42, Issue 6, pp 1478–1484 | Cite as

A Nipple–Areolar Complex Reconstruction in Implant-Based Breast Reconstruction Using a Local Flap and Full-Thickness Skin Graft

  • Jae-Woo Heo
  • Seong Oh Park
  • Ung Sik Jin
Original Article Breast Surgery
  • 186 Downloads

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

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.

Keywords

Mammaplasty Surgical flaps 

Notes

Acknowledgement

None of the authors has a commercial associations or financial interests to disclose. All authors have contributed to this paper and agreed in its readiness for submission. This article has not been submitted elsewhere simultaneously.

References

  1. 1.
    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):40–53CrossRefGoogle Scholar
  2. 2.
    Gougoutas AJ, Said HK, Um G, Chapin A, Mathes DW (2018) Nipple-areola complex reconstruction. Plast Reconstr Surg 141(3):404e–416eCrossRefGoogle Scholar
  3. 3.
    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):441–465CrossRefGoogle Scholar
  4. 4.
    Few JW, Marcus JR, Casas LA, Aitken ME, Redding J (1999) Long-term predictable nipple projection following reconstruction. Plast Reconstr Surg 104(5):1321–1324CrossRefGoogle Scholar
  5. 5.
    Rubino C, Dessy LA, Posadinu A (2003) A modified technique for nipple reconstruction: the ‘arrow flap’. Br J Plast Surg 56:247–251CrossRefGoogle Scholar
  6. 6.
    Nahabedian MY (2007) Nipple reconstruction. Clin Plast Surg 34(1):131–137CrossRefGoogle Scholar
  7. 7.
    Little JW (1984) Nipple-areola reconstruction. Clin Plast Surg 11(2):351e64Google Scholar
  8. 8.
    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):991e6CrossRefGoogle Scholar
  9. 9.
    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):e756e757CrossRefGoogle Scholar
  10. 10.
    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 3:8–12Google Scholar
  11. 11.
    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 62:591–595CrossRefGoogle Scholar
  12. 12.
    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 39:173–175CrossRefGoogle Scholar
  13. 13.
    Sierakowski A, Niranjan N (2011) Star flap with a dermal platform for nipple reconstruction. J Plast Reconstr Aesthet Surg 64:e55–e56CrossRefGoogle Scholar
  14. 14.
    Cuomo R, Sisti A, Grimaldi L, D’Aniello C (2016) Modified arrow flap technique for nipple reconstruction. Breast J 22:710–711CrossRefGoogle Scholar
  15. 15.
    Macdonald CR, Nakhdjevani A, Shah A (2011) The, “Swiss-roll” flap: a modified C-V flap for nipple reconstruction. Breast J 20:475–477CrossRefGoogle Scholar
  16. 16.
    Eo S, Kim SS, Da Lio AL (2007) Nipple reconstruction with C-V flap using dermofat graft. Ann Plast Surg 58:137–140CrossRefGoogle Scholar
  17. 17.
    Mukherjee RP, Gottlieb V, Hacker L (1987) Nipple-areolar reconstruction with buried dermal hammock technique. Ann Plast Surg 19:421–423CrossRefGoogle Scholar
  18. 18.
    Bosch G, Ramirez M (1984) Reconstruction of the nipple: a new technique. Plast Reconstr Surg 73:977–981CrossRefGoogle Scholar
  19. 19.
    Adams WM (1949) Labial transplant for correction of loss of the nipple. Plast Reconstr Surg 4(3):295–298CrossRefGoogle Scholar
  20. 20.
    Gruber RP (1977) Method to produce better areolae and nipples on reconstructed breasts. Plast Reconstr Surg 60(4):505–513CrossRefGoogle Scholar
  21. 21.
    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):360–363CrossRefGoogle Scholar
  22. 22.
    Nimboriboonporn A, Chuthapisith S (2014) Nipple-areola complex reconstruction. Gland Surg 3(1):35PubMedPubMedCentralGoogle Scholar
  23. 23.
    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):68PubMedPubMedCentralGoogle Scholar
  24. 24.
    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 137:14–23CrossRefGoogle Scholar
  25. 25.
    Bernard RW, Beran SJ (2003) Autologous fat graft in nipple reconstruction. Plast Reconstr Surg 112:964–968CrossRefGoogle Scholar
  26. 26.
    Brent B, Bostwick J (1977) Nipple-areola reconstruction with auricular tissues. Plast Reconstr Surg 60:353–361PubMedGoogle Scholar
  27. 27.
    Jones AP, Erdmann M (2012) Projection and patient satisfaction using the “Hamburger” nipple reconstruction technique. J Plast Reconstr Aesthet Surg 65:207–212CrossRefGoogle Scholar
  28. 28.
    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 22:85–97Google Scholar
  29. 29.
    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 56:692–694CrossRefGoogle Scholar
  30. 30.
    Chia HL, Wong M, Tan BK (2014) Nipple reconstruction with rolled dermal graft support. Arch Plast Surg 41:158–162CrossRefGoogle Scholar
  31. 31.
    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 50:31–37CrossRefGoogle Scholar
  32. 32.
    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 59:1063–1067CrossRefGoogle Scholar
  33. 33.
    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–581eCrossRefGoogle Scholar
  34. 34.
    Craft RO, May JW Jr (2011) Staged nipple reconstruction with vascularized SurgiMend acellular dermal matrix. Plast Reconstr Surg 127:148e–149eCrossRefGoogle Scholar
  35. 35.
    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 125:479–481CrossRefGoogle Scholar
  36. 36.
    Nahabedian MY (2005) Secondary nipple reconstruction using local flaps and AlloDerm. Plast Reconstr Surg 115:2056–2061CrossRefGoogle Scholar
  37. 37.
    Tierney BP, Hodde JP, Changkuon DI (2014) Biologic collagen cylinder with skate flap technique for nipple reconstruction. Plast Surg Int 2014:194087PubMedPubMedCentralGoogle Scholar
  38. 38.
    Wong RK, Wichterman L, Parson SD (2008) Skin sparing nipple reconstruction with polytetrafluoroethylene implant. Ann Plast Surg 61:256–258CrossRefGoogle Scholar
  39. 39.
    Jankau J, Jaśkiewicz J, Ankiewicz A (2011) A new method for using a silicone rod for permanent nipple projection after breast reconstruction procedures. Breast 20:124–128CrossRefGoogle Scholar
  40. 40.
    Garramone CE, Lam B (2007) Use of AlloDerm in primary nipple reconstruction to improve long-term nipple projection. Plast Reconstr Surg 119:1663–1668CrossRefGoogle Scholar
  41. 41.
    Jalini L, Lund J, Kurup V (2016) Nipple reconstruction using the CV flap technique: long-term outcomes. Int J Surg Med 2:162–166CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2018

Authors and Affiliations

  1. 1.Department of Plastic and Reconstructive Surgery, Seoul National University College of MedicineSeoul National University HospitalSeoulRepublic of Korea
  2. 2.Department of Plastic and Reconstructive SurgeryHanyang University Seoul HospitalSeoulRepublic of Korea

Personalised recommendations