Browse > Article
http://dx.doi.org/10.5999/aps.2016.43.4.339

A Revision Restoring Projection after Nipple Reconstruction by Burying Four Triangular Dermal Flaps  

Kim, Ji Hun (Department of Plastic and Reconstructive Surgery, Hanyang University Seoul Hospital, Hanyang University College of Medicine)
Ahn, Hee Chang (Department of Plastic and Reconstructive Surgery, Hanyang University Seoul Hospital, Hanyang University College of Medicine)
Publication Information
Archives of Plastic Surgery / v.43, no.4, 2016 , pp. 339-343 More about this Journal
Abstract
Background Numerous techniques have been used to achieve long-term projection of the nipple following nipple-areola reconstruction. However, the reconstructed nipple loses projection over time. We describe a technique that uses local flaps to improve the lost projection of reconstructed nipples. Methods Between November 2013 and March 2015, nine patients (11 nipples) underwent revisional nipple reconstruction for lost projection. Only C-H nipple reconstructions were included in this study. The medical history of each patient was reviewed and photographs were taken in front and lateral views. All patients attended routine follow-up visits. Deepithelialized triangular flaps were made on all four sides of the nipple and buried in the opposite corners in order to augment the volume of the nipple. Anchoring sutures were used to attach each triangular flap on the side opposite their point of origin, and the resulting defects were closed directly. Results This procedure was used successfully in nine patients (11 nipples). Adequate projection was achieved in all patients and no complications occurred. The average nipple height was 3 mm before operation, 7 mm one day after operation, 5 mm at the six-month follow-up, and 5 mm at the 12-month follow-up. The average nipple-areolar angle was $164^{\circ}$ before the operation, $111^{\circ}$ one day after the operation, $130^{\circ}$ at the six-month follow-up, and $133^{\circ}$ at the 12-month follow-up. Conclusions The method described provides a solution to the loss of projection in reconstructed nipples. We recommend this technique because it leads to better projection, greater volume, and a more natural shape.
Keywords
Nipples; Mammoplasty; Surgical flaps;
Citations & Related Records
Times Cited By KSCI : 1  (Citation Analysis)
연도 인용수 순위
1 Little JW. Nipple-areolar reconstruction. In: Cohen M, editor. Mastery of plastic and reconstructive surgery. Boston: Little, Brown; 1994. p.1342-8.
2 Bhatty MA, Berry RB. Nipple-areola reconstruction by tattooing and nipple sharing. Br J Plast Surg 1997;50:331-4.   DOI
3 Kroll SS. Integrated breast mound reduction and nipple reconstruction with the wraparound flap. Plast Reconstr Surg 1999;104:687-93.   DOI
4 Thomas SV, Gellis MB, Pool R. Nipple reconstruction with a new local tissue flap. Plast Reconstr Surg 1996;97:1053-6.   DOI
5 Ramakrishnan VV, Mohan D, Villafane O, et al. Twin flap technique for nipple reconstruction. Ann Plast Surg 1997; 39:241-4.   DOI
6 Jabor MA, Shayani P, Collins DR Jr, et al. Nipple-areola reconstruction: satisfaction and clinical determinants. Plast Reconstr Surg 2002;110:457-63.   DOI
7 Bernard RW, Beran SJ. Autologous fat graft in nipple reconstruction. Plast Reconstr Surg 2003;112:964-8.   DOI
8 Tanabe HY, Tai Y, Kiyokawa K, et al. Nipple-areola reconstruction with a dermal-fat flap and rolled auricular cartilage. Plast Reconstr Surg 1997;100:431-8.   DOI
9 Kim DY, Jeong EC, Eo SR, et al. Correction of inverted nipple: an alternative method using two triangular areolar dermal flaps. Ann Plast Surg 2003;51:636-40.   DOI
10 Wu HL, Huang X, Zheng SS. A new procedure for correction of severe inverted nipple with two triangular areolar dermofibrous flaps. Aesthetic Plast Surg 2008;32:641-4.   DOI
11 Chia HL, Wong M, Tan BK. Nipple reconstruction with rolled dermal graft support. Arch Plast Surg 2014;41:158-62.   DOI
12 Nahabedian MY. Secondary nipple reconstruction using local flaps and AlloDerm. Plast Reconstr Surg 2005;115:2056-61.   DOI
13 Shestak KC, Gabriel A, Landecker A, et al. Assessment of long-term nipple projection: a comparison of three techniques. Plast Reconstr Surg 2002;110:780-6.   DOI
14 Peled IJ. Purse-string suture for nipple projection. Plast Reconstr Surg 1999;103:1480-2.   DOI
15 Burm JS, Kim YW. Correction of inverted nipples by strong suspension with areola-based dermal flaps. Plast Reconstr Surg 2007;120:1483-6.   DOI
16 Yamada N, Kakibuchi M, Kitayoshi H, et al. A method for correcting an inverted nipple with an artificial dermis. Aesthetic Plast Surg 2004;28:233-8.   DOI
17 Few JW, Marcus JR, Casas LA, et al. Long-term predictable nipple projection following reconstruction. Plast Reconstr Surg 1999;104:1321-4.   DOI
18 Park IY, Kim MR, Jo HH, et al. Association of the nipple-areola complexes with age, parity, and breastfeeding in Korean premenopausal women. J Hum Lact 2014;30:474-9.   DOI