Biologic Collagen Cylinder with Skate Flap Technique for Nipple Reconstruction

Abstract

A surgical technique using local tissue skate flaps combined with cylinders made from a naturally derived biomaterial has been used effectively for nipple reconstruction. A retrospective review of patients who underwent nipple reconstruction using this technique was performed. Comorbidities and type of breast reconstruction were collected. Outcome evaluation included complications, surgical revisions, and nipple projection. There were 115 skate flap reconstructions performed in 83 patients between July 2009 and January 2013. Patients ranged from 32 to 73 years old. Average body mass index was 28.0. The most common comorbidities were hypertension (39.8%) and smoking (16.9%). After breast reconstruction, 68.7% of the patients underwent chemotherapy and 20.5% underwent radiation. Seventy-one patients had immediate breast reconstruction with expanders and 12 had delayed reconstruction. The only reported complications were extrusions (3.5%). Six nipples (5.2%) in 5 patients required surgical revision due to loss of projection; two patients had minor loss of projection but did not require surgical revision. Nipple projection at time of surgery ranged from 6 to 7 mm and average projection at 6 months was 3–5 mm. A surgical technique for nipple reconstruction using a skate flap with a graft material is described. Complications are infrequent and short-term projection measurements are encouraging.

Nipple Reconstruction Techniques: Which is the Best Choice?

“…Other allogenic material employed as augmentation grafts for nipple reconstruction were: lyophilized Costal Cartilage and extracellular matrix collagen [57,58].…”

“…Tierney et al [58] used extracellular matrix collagen of porcine small intestinal submucosa origin (Biodesign Nipple Reconstruction Cylinder; Cook, Inc., Bloomington, IN, USA) shaped into rolled cylinder as augmentation graft along with skate flap for nipple reconstruction. At 6 months, loss of projection ranged from 30 to 50%, and reconstructed nipples were 3 to 5 mm high.…”

A Systematic Review of Comparison of Autologous, Allogeneic, and Synthetic Augmentation Grafts in Nipple Reconstruction

“…Tierney et al 30 used a rolled cylinder of extracellular matrix collagen derived from porcine small intestinal submucosa (Biodesign Nipple Reconstruction Cylinder; Cook, Inc., Bloomington, Ind.) in 83 women and reported a 30 to 50 percent projection loss at follow-up.…”

“…23 Reported allogeneic materials have included acellular dermal matrix, [24][25][26][27][28][29] bone allograft, 16 and extracellular matrix collagen. 30 Silicone, 31 polyurethane, 32 polytetrafluoroethylene, 33 and calcium hydroxylapatite gel 34 are the synthetic materials described to date for use in nipple augmentation. Combinations of the above materials have also been reported.…”

Nipple Reconstruction with the Biodesign Nipple Reconstruction Cylinder: A Prospective Clinical Study

“…9,10 These materials include devices made from small intestinal submucosa (SIS) 9 or human acellular dermis. 10 The Biodesign Nipple Reconstruction Cylinder (NRC; Cook Biotech Incorporated, West Lafayette, Ind.)…”