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The "half-dome" Technique For Nipple Reconstruction: Combination Local Flap And Full-thickness Skin Graft
Chen W; Pang JHY; De La Cruz, C.
University of Pittsburgh Medical Center
2017-01-27
Presenter: Wendy Chen, MD, MS
Affidavit:
This work was mostly conceived by the attending physician, but mostly executed and written up by the submitting resident.
Director Name: Vu T Nguyen
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Background
Nipple areolar complex (NAC) reconstruction is an important final step in breast reconstruction. While patient-reported satisfaction is high, objective assessment of the quality of nipple reconstruction is low. It can be difficult to reproduce a realistic NAC which maintains long-term projection.
Methods
This is a retrospective review of a single-surgeon's experience at our institution (2010-2016) using a modified local flap combined with full-thickness skin graft for NAC reconstruction. Patients included had at least 12 months of follow-up and documented nipple projection.
Results
Twenty-eight patients (44 nipples) met the inclusion criteria (Free flap, n=4; latissimus flap (LD), n=4; implant only reconstruction, n=17). In the free flap cohort, nipple projection averaged 2.8mm (6 nipples, none radiated, ave f/u 30mos). In the LD cohort, nipple projection averaged 1.9mm (5 nipples, 1 radiated, ave f/u 35mos). In the implant only cohort, nipple projection averaged 1.7mm (30 nipples, 1 radiated, ave f/u 25mos). None of the patients decided to undergo additional tattoo.
Discussion
We present a new technique that offers a natural appearing NAC with long-lasting projection and excellent patient satisfaction, without the need or additional cost of further tattoo. The complication rate is low, the technique is simple and reproducible, with minimal scars and minimal operating room time. The long-term projection maintained using this technique is comparable to that reported in previous reports, however, we feel the appearance is more realistic. There is a trend of better vascularized reconstructions (i.e. flaps) having better nipple projection.
