Ann Surg Treat Res.  2019 Jan;96(1):8-13. 10.4174/astr.2019.96.1.8.

Dimensional changes in reconstructed nipples: autologous versus prosthetic breast reconstruction

• Yang CE
• Park KH
• Lew DH
• Roh TS
• Lee DW

• KMID: 2429748
• DOI: http://doi.org/10.4174/astr.2019.96.1.8

Abstract

PURPOSE
The creation of the nipple-areola complex is the final stage in breast reconstruction and highly affects patient satisfaction. The neo-nipple is well known to shrink over time, particularly in the nipple projection. Currently, no reconstruction technique is clearly superior in terms of nipple size maintenance. We evaluated nipple size changes among several methods of breast mound reconstruction.
METHODS
Seventy-eight patients received nipple-areola complex reconstruction secondarily after breast reconstruction. C-V flap nipple reconstructions were performed using a free transverse rectus abdominis myocutaneous (TRAM) flap in 25 cases (TRAM group), a latissimus dorsi (LD) myocutaneous flap in 27 cases (LD group), and an implant in 26 cases (implant group). The circumference and projection of the neo-nipple were measured using a flexible ruler, immediately after reconstruction and average 10 months after surgery.
RESULTS
The overall circumference and projection at the final measurement were 91.43% ± 7.11% and 62.16% ± 21.55%, respectively, of immediate postoperative values. The change in circumference did not significantly differ among the 3 groups. In contrast, the change in projection was significantly worse in implant group compared to that in TRAM and LD groups. In addition, among the patients in implant group, greater inflation was significantly associated with greater decrease in the nipple projection.
CONCLUSION
Breast mound reconstruction with autologous musculocutaneous flap techniques achieves better long-term maintenance of the neo-nipple projection compared to that achieved with expanded tissue and implantation. Considering the prospective loss of long-term nipple dimension, the preoperative design should be oversized in accordance with its origin in mound reconstruction.

Keyword

Mammaplasty; Reconstructive surgical procedures

MeSH Terms

Breast*
Female
Humans
Inflation, Economic
Mammaplasty*
Myocutaneous Flap
Nipples*
Patient Satisfaction
Prospective Studies
Reconstructive Surgical Procedures
Rectus Abdominis
Superficial Back Muscles

Figure

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  Fig. 1 Nipple reconstruction using a modified C-V flap technique. One C flap and 2 rounded V-flaps were elevated from the reconstructed breast mound while preserving dermis and fat tissue. After thinning of subcutaneous fat tissue, bilateral wings of the rounded V-flap were sutured with nylon. The C-flap and V-flap donor sites were closed primarily.

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  Fig. 2 Comparison of the change in nipple circumference and projection among various reconstruction methods. Nipples from autologous tissue showed more stability than nipples from expanded tissue. *P < 0.05.

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  Fig. 3 Pearson correlations and scatterplot depicting the relationship between expansion and nipple projection changes among the patients in implant group. In group C, as the amount of postoperative expansion increases, the rate of projection decrease is greater (P < 0.003).

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