Nipple Reconstruction with Rolled Dermal Graft Support

Background Loss of nipple projection is a common problem following nipple reconstruction. The aim of this study was to demonstrate that the use of a tightly rolled dermal graft is effective in the long-term maintenance of nipple projection.

Methods Nipple reconstruction was performed using the C-V flap technique. A dermal graft was harvested from the dog-ear portion of previous scars. The graft was rolled tightly into a compact cylinder and used to augment the nipple reconstruction. Postoperatively, stacked Allevyn dressing was used for protecting the nipple from compression for a minimum of two months. Nipple projection was measured at the time of surgery and at 12 months postoperatively.

Results Forty nipple reconstructions were performed using this technique. There were 19 transverse rectus abdominis musculocutaneous (TRAM) flaps, 10 latissimus dorsi (LD) flaps, and 11 tissue-expanded breast mounds. At one year, the mean projection was 0.80 cm (range, 0.62-1.22 cm). The twelve-month average maintenance of nipple projection was 70.2% for the TRAM flap group, 76.3% for the LD flap group, and 61.8% for the tissue-expanded group. In two patients with previous irradiation of the reconstructed breasts, relatively poor maintenance of nipple projection was noted (45.7%). No complications were noted, and all of the donor sites healed well primarily.

Conclusions Our results demonstrated that the use of a C-V flap with a tightly rolled dermal graft for nipple reconstruction improves the long-term maintenance of nipple projection. Its advantages include reproducibility, technical simplicity, cost-effectiveness, and minimal donor site morbidity.

Keywords

Mammaplasty - Nipples - Dermis - Transplants

Publication History

Received: 09 June 2013

Accepted: 28 October 2013

Article published online:
02 May 2022

• REFERENCES

• 1 Boccola MA, Savage J, Rozen WM. et al. Surgical correction and reconstruction of the nipple-areola complex: current review of techniques. J Reconstr Microsurg 2010; 26: 589-600
• 2 Jones G, Bostwick III J. Nipple-areolar reconstruction. Oper Tech Plast Reconstr Surg 1994; 1: 35-38
• 3 Shestak KC, Gabriel A, Landecker A. et al. Assessment of long-term nipple projection: a comparison of three techniques. Plast Reconstr Surg 2002; 110: 780-786
• 4 Losken A, Mackay GJ, Bostwick 3rd J. Nipple reconstruction using the C-V flap technique: a long-term evaluation. Plast Reconstr Surg 2001; 108: 361-369
• 5 Few JW, Marcus JR, Casas LA. et al. Long-term predictable nipple projection following reconstruction. Plast Reconstr Surg 1999; 104: 1321-1324
• 6 Valdatta L, Montemurro P, Tamborini F. et al. Our experience of nipple reconstruction using the C-V flap technique: 1 year evaluation. J Plast Reconstr Aesthet Surg 2009; 62: 1293-1298
• 7 Davis RE, Guida RA, Cook TA. Autologous free dermal fat graft. Reconstruction of facial contour defects. Arch Otolaryngol Head Neck Surg 1995; 121: 95-100
• 8 Eo S, Kim SS, Da Lio AL. Nipple reconstruction with C-v flap using dermofat graft. Ann Plast Surg 2007; 58: 137-140
• 9 Tanabe HY, Tai Y, Kiyokawa K. et al. Nipple-areola reconstruction with a dermal-fat flap and rolled auricular cartilage. Plast Reconstr Surg 1997; 100: 431-438
• 10 Guerra AB, Khoobehi K, Metzinger SE. et al. New technique for nipple areola reconstruction: arrow flap and rib cartilage graft for long-lasting nipple projection. Ann Plast Surg 2003; 50: 31-37
• 11 Klatsky SA, Manson PN. Toe pulp free grafts in nipple reconstruction. Plast Reconstr Surg 1981; 68: 245-248
• 12 Wong RK, Wichterman L, Parson SD. Skin sparing nipple reconstruction with polytetrafluoroethylene implant. Ann Plast Surg 2008; 61: 256-258
• 13 Yanaga H. Nipple-areola reconstruction with a dermal-fat flap: technical improvement from rolled auricular cartilage to artificial bone. Plast Reconstr Surg 2003; 112: 1863-1869
• 14 Evans KK, Rasko Y, Lenert J. et al. The use of calcium hydroxylapatite for nipple projection after failed nipple-areolar reconstruction: early results. Ann Plast Surg 2005; 55: 25-29
• 15 Garramone CE, Lam B. Use of AlloDerm in primary nipple reconstruction to improve long-term nipple projection. Plast Reconstr Surg 2007; 119: 1663-1668
• 16 Holton LH, Haerian H, Silverman RP. et al. Improving long-term projection in nipple reconstruction using human acellular dermal matrix: an animal model. Ann Plast Surg 2005; 55: 304-309
• 17 Chen WF, Barounis D, Kalimuthu R. A novel cost-saving approach to the use of acellular dermal matrix (AlloDerm) in postmastectomy breast and nipple reconstructions. Plast Reconstr Surg 2010; 125: 479-481
• 18 Hammond DC, Khuthaila D, Kim J. The skate flap purse-string technique for nipple-areola complex reconstruction. Plast Reconstr Surg 2007; 120: 399-406
• 19 Nahabedian MY. Secondary nipple reconstruction using local flaps and AlloDerm. Plast Reconstr Surg 2005; 115: 2056-2061