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Long-Term Outcome of Nipple Projection Maintenance After Reconstruction with Clover Flap Technique

  • Original Article
  • Breast Surgery
  • Published:
Aesthetic Plastic Surgery Aims and scope Submit manuscript

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

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Authors and Affiliations

  1. Department of Plastic and Reconstructive Surgery, Tokyo Medical University, 6-7-1 Nishishinjyuku Shinjyuku-ku, Tokyo, 160-0023, Japan

    Takako Komiya & Hajime Matsumura

  2. Breast Surgery Clinic, Tokyo, Japan

    Yoshiko Iwahira

  3. Department of Breast Surgery, Tokyo Medical University, Tokyo, Japan

    Takashi Ishikawa

Authors
  1. Takako Komiya
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  2. Yoshiko Iwahira
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  3. Takashi Ishikawa
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  4. Hajime Matsumura
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Corresponding author

Correspondence to Takako Komiya.

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The authors declare that they have no conflicts of interest associated with this study.

Informed Consent

This study was reviewed and approved by our institutional review board, and informed consent was obtained from all subjects.

Human and Animal Rights

All procedures performed involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments.

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Komiya, T., Iwahira, Y., Ishikawa, T. et al. Long-Term Outcome of Nipple Projection Maintenance After Reconstruction with Clover Flap Technique. Aesth Plast Surg 45, 1487–1494 (2021). https://doi.org/10.1007/s00266-021-02170-1

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  • DOI: https://doi.org/10.1007/s00266-021-02170-1

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