Nipple reconstruction using rib cartilage strut in microsurgical reconstructed breast

Guerid, Samia; Boucher, F.; Mojallal, Ali

doi:10.1016/j.anplas.2017.02.002

Cited by 6 publications

(7 citation statements)

References 12 publications

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“…Autologous tissues include dermis [ 34 , 35 ], adipose tissue [ 36 ], cartilage (from the ribs or the outer ear) and mucosa (from the gums of the oral cavity or the rima ani at the coccygeal level) [ 1 ]. Costal rib cartilage can be harvested during free flap-based BR procedures, when internal mammary vessels are selected as recipient site [ 37 , 38 ]. In these cases, internal mammary vessel dissection requires the resection of a small portion of costal cartilage which can be banked and reused for augmentation grafting of the reconstructed nipple.…”

Section: Resultsmentioning

confidence: 99%

Guiding Nipple-Areola Complex Reconstruction: Literature Review and Proposal of a New Decision-Making Algorithm

et al. 2020

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Background Nipple-areola complex reconstruction (NAR) most commonly represents the finishing touch to breast reconstruction (BR). Nipple presence is particularly relevant to the patient’s psyche, beyond any shadow of doubt. Many reconstructive options have been described in time. Surgery is easy, but final result is often disappointing on the long run. Methods The goal of this manuscript is to analyze and classify knowledge concerning NAR techniques and the factors that influence success, and then to elaborate a practical evidence-based algorithm. Out of the 3136 available articles as of August 8th, 2020, we selected 172 manuscripts that met inclusion criteria, which we subdivided into 5 main topics of discussion, being the various NAR techniques; patient factors (including patient selection, timing and ideal position); dressings; potential complications and finally, outcomes/patient satisfaction. Results We found 92 articles describing NAR techniques, 41 addressing patient factors (out of which 17 discussed patient selection, 14 described ideal NAC location, 10 described appropriate timing), 10 comparing dressings, 7 studying NAR complications, and 22 addressing outcomes and patient satisfaction. We elaborated a comprehensive decision-making algorithm to help narrow down the choice among NAR techniques, and choose the correct strategy according to the various scenarios, and particularly the BR technique and skin envelope. Conclusions No single NAR technique provides definitive results, which is why we believe there is no “end-all be-all solution”. NAR must be approached as a case-by-case situation. Furthermore, despite NAR being such a widely discussed topic in scientific literature, we still found a lack of clinical trials to allow for more thorough recommendations to be elaborated. Level of Evidence III This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266

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Section: Resultsmentioning

confidence: 99%

Guiding Nipple-Areola Complex Reconstruction: Literature Review and Proposal of a New Decision-Making Algorithm

et al. 2020

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“…16–19 However, these techniques resulted in a higher complication rate using local skin flaps with grafts, and yielded an excessively stiff, unnatural neonipple. 13,16–18,29,36…”

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

“…27 However, polylactic acid, which takes at least 3 to 5 years to degrade within the body, is an inappropriate biomaterial for this application because the prolonged rigidity of the neonipple would likely be a source of patient dissatisfaction, and the excessive stiffness would increase the risk of scaffold erosion or extrusion in a manner similar to an autologous cartilage graft. 17,18,28,29 In this study, we used 3D-printed poly-4-hydroxybutyrate (P4HB) scaffolds with mechanically processed CC or internal P4HB 3D latticework to engineer neonipples with long-term projection. P4HB, a U.S. Food and Drug Administrationapproved biopolymer used in a variety of commercially available medical devices, was selected for its superior biocompatibility, tunable strength, and adjustable absorption rate.…”

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confidence: 99%

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Long-Term Maintenance of Projection of Nipples Reconstructed Using Three-Dimensionally Printed Poly-4-Hydroxybutyrate Bioabsorbable Scaffolds

Dong

Shih

Premaratne

et al. 2023

Plastic &Amp; Reconstructive Surgery

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Background: For patients who are unable to undergo nipple-sparing mastectomy, reconstruction of the nipple-areola complex has been shown to promote greater satisfaction in cosmetic outcome, body image, and sexual relationships. Although a variety of techniques have been developed to optimize the shape, size, and mechanical properties of the reconstructed nipple-areola complex, maintenance of sustained nipple projection over time remains a challenge for plastic surgeons. Methods: Three-dimensionally printed poly-4-hydroxybutyrate (P4HB) scaffolds were designed and fabricated filled with either mechanically minced or zested patient-derived costal cartilage, designed with an internal P4HB lattice (rebar) to provide interior structure to foster tissue ingrowth, or left unfilled. All scaffolds were wrapped within a C-V flap on the dorsa of a nude rat. Results: One year after implantation, neonipple projection and diameter were well preserved in all scaffolded groups compared with nonscaffolded neonipples (P < 0.05). Histologic analysis showed significant vascularized connective tissue ingrowth at 12 months in both empty and rebar-scaffolded neonipples and fibrovascular cartilaginous tissue formation in mechanically processed costal cartilage–filled neonipples. The internal lattice promoted more rapid tissue infiltration and scaffold degradation and best mimicked the elastic modulus of the native human nipple after 1 year in vivo. No scaffolds extruded or caused any mechanical complications. Conclusions: Three-dimensionally printed biodegradable P4HB scaffolds maintain diameter and projection while approximating the histologic appearance and mechanical properties of native human nipples after 1 year with a minimal complication profile. These long-term preclinical data suggest that P4HB scaffolds may be readily translated for clinical application. Clinical Relevance Statement: The authors’ unique, three-dimensionally printed P4HB scaffolds can be used to create custom nipple scaffolds that contour to any nipple shape and size, enabling the fabrication of tissue-engineered neonipples with significantly greater projection maintenance and closely approximating desired nipple biomechanical properties.

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“…To overcome the loss of projection, several material grafts have been proposed inside the new nipple: autologous tissue (fat [ 33 ], cartilage [ 25 , 34 , 35 , 36 , 37 , 38 ], derma [ 39 ]), allogeneic tissue (acellular dermal matrix [ 40 , 41 ], lyophilized allogeneic costal cartilage [ 42 ]), and synthetic materials (fillers [ 43 , 44 , 45 ] et al [ 46 , 47 ]) can be grafted inside the nipple. Winocour et al [ 18 ] have published an interesting review on this topic, concluding that the autologous tissue grafted inside the nipple has led to the best results.…”

Section: Use Of Autologous/allogenic/synthetic Grafts To Improve Nmentioning

confidence: 99%

Nipple–Areola Complex Reconstruction

Sisti

2020

Medicina

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Nipple reconstruction using rib cartilage strut in microsurgical reconstructed breast

Cited by 6 publications

References 12 publications

Guiding Nipple-Areola Complex Reconstruction: Literature Review and Proposal of a New Decision-Making Algorithm

Guiding Nipple-Areola Complex Reconstruction: Literature Review and Proposal of a New Decision-Making Algorithm

Long-Term Maintenance of Projection of Nipples Reconstructed Using Three-Dimensionally Printed Poly-4-Hydroxybutyrate Bioabsorbable Scaffolds

Nipple–Areola Complex Reconstruction

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