Secondary nipple reconstruction using two surgical techniques

Background Although the initial projection after primary nipple reconstruction is excellent, nipple projection gradually flattens in most cases due to multiple causes. Although various methods have been reported to rebuild the nipple after nipple flattening, the most effective method of secondary nipple reconstruction remains unknown. The aim of this study was to review our institution’s experiences with secondary nipple reconstruction.Methods We conducted a retrospective review from March 2012 to January 2019. We performed secondary nipple reconstruction if the primary reconstructed nipple height differed by more than 6 mm from the normal nipple height. We chose the method of nipple revision according to the degree of tissue scarring and the remaining nipple projection.Results We performed secondary nipple reconstruction on a total of 27 nipples, using pursestring sutures for 19 nipples and star flaps in eight nipples. The median follow-up period was 8 months (range, 6–19 months) after the final nipple reconstruction. Among the 19 nipples reconstructed using purse-string sutures, 10 (53%) demonstrated acceptable projection of more than 5 mm. Among the eight nipples reconstructed using star flaps, six (75%) showed acceptable projection of more than 5 mm. Most of the patients (73%) were satisfied (scores of 4 or 5) with the nipple reconstruction overall.Conclusions Few studies have presented favorable outcomes of secondary nipple reconstruction. When the star flap and purse-string suture methods were used depending on the remaining nipple height and scarring, appropriate projection could be achieved.

A novel technique for an immediate nipple reconstruction with a rectangle flap in implant-based breast reconstruction

IntroductionA nipple reconstruction complements breast mound restoring in postmastectomy breast cancer patients. It positively affects patients' welfare, both in psycho-social and sexual aspects. An immediate nipple reconstruction is an alternative approach to delayed surgery. We describe an original technique for an immediate nipple reconstruction by the use of a modified rectangular flap.Material and methodsOne hundred seventeen nipple reconstructions in 112 breast cancer patients were performed. This technique was used during skin-sparing mastectomy, including 104 implants (88.9%) and 13 tissue-expander (11.1%) breast reconstructions. Synthetic meshes covered with titanium supported lower breast poles in 72 implantations (61.5%); in remaining cases, (38.5%) muscles covered the entire implant. Preoperative chemotherapy was applied in 18.75% of the patients; adjuvant chemo- and hormonal therapy obtained 29.5% and 74.1% of the patients, respectively. Twenty-four patients (21.4%) were irradiated postoperatively.ResultsIn 5 out of 117 surgeries (4.3%), necrosis of the rectangular flap was observed. Twelve months since surgery, two-loss of projection of reconstructed nipple was reported (1.7%). In the twelfth month of observation, of the subgroup of 102 patients with permanent nipple presentation, 93.1% gave a positive opinion regarding the procedure.ConclusionsThe given immediate nipple reconstruction technique performed during a skin-sparing mastectomy and implant/expander-based breast reconstruction was an effective and safe adjunct curative breast surgery.

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

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.

Outcomes of Breast Free Flap Reconstruction in the Middle East

Objectives: Reviewing patient satisfaction and quality of life following post mastectomy breast reconstruction in breast cancer patients of Middle East. Methods: Retrospective study of 68 patients of post mastectomy who underwent free flap-based breast reconstruction with a mean follow up of 6 months were studied over a period of 5½ years. Specific preoperative investigation included CT angiography of the abdominal wall for perforator assessment. All of breasts were reconstructed by microsurgical free flap breast reconstruction. A questionnaire was developed for the postoperative patients in order to assess their satisfaction grades. Results: A total of 67 patients of post mastectomy females attended to our clinic for breast reconstruction. Most of the patients (97.3%) were in the age group of 29-53 years. Majority of patients (68%) underwent delayed reconstruction. Average BMI at reconstruction in most females was 30.1. CT angio demonstrated two ideal perforators in 59% of cases. Majority underwent reconstruction by free DIEP flap. Complications occurred in 6.4% of patients. Overall satisfaction rates of 92% was noted. At the completion of the study 30% has completed nipple reconstruction. Conclusion: With the availability of “state of the art” microsurgical breast reconstruction, in properly selected patients, the quality of life and satisfaction rates are high and free flap breast reconstruction has proven to be the standard of care in post mastectomy patient population.

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.