Long V-Y advancement technique for large nipple reconstruction in Asian women

Previously reported nipple-areolar complex reconstruction (NAR) methods involve multiple incisions and wide skin redraping, which increase retraction forces and heighten the risk of nipple-areolar complex (NAC) flattening. We introduce a NAR method using the long V-Y advancement technique that can overcome these disadvantages. A V-shaped flap is designed with the width of the flap base 4–5 mm larger than the diameter of the normal nipple. The flap length is designed to be at least 2.5 times its width. Dissection is performed to the top of the artificial dermal matrix or muscle layer. The nipple is constructed with the same projection as the contralateral side by folding the elevated flap. The tip of the elevated flap is apposed in the middle of the donor defect to minimize the deformity during donor site closure. A 3-point skin suture is applied to the upper third of the folded flap to mold its shape. Using this long V-Y advancement technique, we successfully decreased skin tension in NAC flaps and improved the maintenance of reconstructed nipple projection. The long V-Y advancement technique provides an easy, simple NAR method, effectively maintaining longer nipple projections and reducing breast deformities, especially in Asian women with relatively large nipples.

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Nipple-Areolar Complex Reconstruction with Acellular Dermal Matrix

Nipple-Areolar Complex Reconstruction ◽

10.1007/978-3-319-60925-6_47 ◽

2018 ◽

pp. 389-392

Author(s):

Steven P. Davison ◽

Kelly A. Scriven

Keyword(s):

Acellular Dermal Matrix ◽

Dermal Matrix ◽

Nipple Areolar Complex ◽

Areolar Complex ◽

Complex Reconstruction ◽

Acellular Dermal

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Nipple Reconstruction Techniques: Which is the Best Choice?

Open Medicine Journal ◽

10.2174/1874220301805010062 ◽

2018 ◽

Vol 5 (1) ◽

pp. 62-75 ◽

Cited By ~ 1

Author(s):

Nicolò Bertozzi ◽

Francesco Simonacci ◽

Marianna Pesce ◽

PierLuigi Santi ◽

Edoardo Raposio

Keyword(s):

Donor Site ◽

Donor Site Morbidity ◽

Contralateral Side ◽

Skin Thickness ◽

Nipple Reconstruction ◽

Areolar Complex ◽

Long Term Follow Up ◽

Case Basis

Nipple-Areolar Complex (NAC) reconstruction represents the final, concluding journey of breast reconstruction by being able to give to reconstructed breasts the shape of a natural breast mound. Nevertheless an enormous amount of nipple reconstruction techniques are described in literature, given the fact that most reconstructive options fail to give satisfactory outcomes in relation to the long-term nipple projection. In this review, the authors will browse most common nipple reconstruction techniques, taking into account: Indication, outcome, and side effect. Composite nipple grafts, traditional flaps, flaps with autologous graft augmentation, flaps with allograft augmentation, and flaps with alloplastic augmentation are the main strategies employed nowadays. Composite nipple grafts give the best guarantee of color-texture match with the contralateral side and show satisfactory nipple projection even at long-term follow-up. Skate, star, C-V, and arrow flap are by far the most commonly employed and the most reliable local flaps, however loss of projection of up to 70 percent are reported in literature. Alloplastic grafts were associated with the lowest rates of projection loss followed by autologous and allogenic ones. Nevertheless allogenic grafts are also associated with the highest complication rate, while autologous and allogenic ones have similar rates. Infection, seroma, and fat necrosis are the more commonly reported complications of autologous grafting along with donor site morbidity, while allogenic and alloplastic augmentation grafts may also experience the risk of overcorrection and graft exposure. Given the numerous techniques described in literature it is clear that the ideal nipple reconstruction hasn’t been found yet. Whereas it should be chosen on case to case basis depending on type of mastectomy, radiotherapy, type of reconstruction, skin thickness, tissue condition, and patients’ expectations to ensure the best cosmetic outcome.

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MEDPOR Nipple Implant Causing Failure of Previously Stable Breast Implant

Plastic Surgery Case Studies ◽

10.1177/2513826x17754056 ◽

2018 ◽

Vol 4 ◽

pp. 2513826X1775405

Author(s):

Zach Zhang ◽

Murray Allen ◽

Kirsty U. Boyd

Keyword(s):

Breast Reconstruction ◽

Breast Implant ◽

Nipple Reconstruction ◽

Review Of The Literature ◽

Synthetic Material ◽

Level Of Evidence ◽

Nipple Areolar Complex ◽

Synthetic Materials ◽

Areolar Complex ◽

Pros And Cons

Reconstruction of the nipple–areolar complex usually marks the final stage of breast reconstruction in postmastectomy patients. There are many approaches to the nipple reconstruction using autologous, allogenic, and synthetic materials. However, different methods have their own pros and cons and there is no current consensus for the best technique. A review of the literature showed that there is a low level of evidence for synthetic material–based nipple reconstruction providing the best nipple projection, but it is also associated with more complication. We present a case where revision of nipple reconstruction with MEDPOR implant overlying an implant-based breast reconstruction preceded the loss of both the nipple and breast construction secondary to infection.

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Nipple areolar complex reconstruction is an integral component of chest reconstruction in the treatment of transgender and gender diverse people

International Journal of Transgenderism ◽

10.1080/15532739.2019.1568343 ◽

2019 ◽

Vol 20 (1) ◽

pp. 1-3

Keyword(s):

Nipple Areolar Complex ◽

Integral Component ◽

Gender Diverse ◽

Areolar Complex ◽

Complex Reconstruction ◽

And Gender

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Skin Sparing Mastectomy with Circumareolar Incision and Immediate TRAM and One-Stage Star Flap Nipple-Areolar Complex Reconstruction

Journal of Korean Breast Cancer Society ◽

10.4048/jkbcs.1999.2.2.190 ◽

1999 ◽

Vol 2 (2) ◽

pp. 190

Author(s):

Sei Hyun Ahn ◽

Pyong Chan Lee ◽

Byung Ho Son ◽

Sang Hoon Han

Keyword(s):

Nipple Areolar Complex ◽

One Stage ◽

Areolar Complex ◽

Complex Reconstruction

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One injection for a great projection: a quick and simple procedure for nipple reconstruction

Archives of Plastic Surgery ◽

10.5999/aps.2019.01095 ◽

2021 ◽

Vol 48 (2) ◽

pp. 179-184

Author(s):

Sara Tanini ◽

Sara Calabrese ◽

Elena Lucattelli ◽

Giulia Lo Russo

Keyword(s):

Simple Procedure ◽

Donor Site ◽

Three Dimensional ◽

Donor Site Morbidity ◽

Single Step ◽

Nipple Reconstruction ◽

Breast Cancer Patients ◽

Reconstruction Process ◽

Areolar Complex ◽

Wound Matrix

Women attach great importance to the presence of a three-dimensional nipple upon completion of the breast reconstruction process. To meet patients’ expectations, nipple-areolar complex reconstruction should achieve symmetry in position, size, shape, texture, and color, as well as minimizing donor-site morbidity. However, it is well known that regardless of the reconstructive technique, loss of nipple projection can be reasonably expected. We developed and evaluated a quick, simple, and innovative technique using injectable Integra Flowable Wound Matrix to increase nipple projection after reconstruction. Twenty breast cancer patients who underwent nipple reconstruction resulting in unsatisfactory projection were enrolled in our retrospective study. Nipple projection was measured at the time of surgery and after 6 and 12 months. A visual analogue scale was used to assess patients’ satisfaction. Our technique yielded reliable results in terms of the long-lasting maintenance of nipple projection. This method is high-priced, but cost-effective, since one kit may suffice for three patients. Furthermore, our patients were very appreciative of this technique as a single-step, minimally invasive, painless procedure with no reported necessity of re-intervention.

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