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Autologous Dermal Fat Graft Modification for Skate Flap Nipple Reconstruction
David E. Kurlander, George Collis, Steven Bernard
University (Case Western Reserve University School of Medicine, Cleveland Clinic Foundation)
2014-02-03
Presenter: David E. Kurlander
Affidavit:
The material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. The work is entirely that of the medical student, resident, and surgeon involved.
Director Name: Steven Bernard
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
PURPOSE: Nipple volume loss is a common source of patient and surgeon dissatisfaction in nipple reconstruction. We describe our surgical technique, supplementing skate flaps with an autologous dermal skin graft, and review our outcomes.
METHODS: We retrospectively reviewed all patients of a single surgeon (S.B.) receiving skate flaps supplemented with an autologous dermal skin graft. In these patients, skin and fat were excised from the lateral abdomen along the scar line or from the lower abdomen above the pubic hairline, depending on breast reconstruction procedure. The donor region was deepithelialized and the skin saved. A unit of deepithelialized dermis and subcutaneous fat measuring approximately 10mm x 5mm x 5mm was harvested using scissors. Skate flaps were elevated at the level of the dermis and brought together to form a cone in typical fashion. Interrupted 3-0 chromic sutures were placed, leaving an opening at the distal end of the neo-nipple. The graft was placed between flaps. The remainder of the flaps was secured primarily around the graft. Finally, a full thickness skin graft was used to reconstruct the areola.
RESULTS: We identified 48 patients between 5/2011 to 9/2013. There were no major complications and no reported extrusions of dermal fat grafts. All patients were satisfied with the results by questioning at final follow-up.
CONCLUSIONS: Nipple reconstruction with autologous dermal fat graft supplement is a simple, safe, and cost-effective means to improve nipple volume. Benefits include no added incisions in abdominal reconstruction patients and more superficial dissection in implant reconstruction patients.
