Surgical Correction and Reconstruction of the Nipple-Areola Complex: Current Review of Techniques

Boccola, Mark A.; Savage, Jessica Anne; Rozen, Warren M.; Ashton, Mark W.; Milner, Chris S.; Rahdon, Richard; Whitaker, Iain S.

doi:10.1055/s-0030-1263290

Cited by 33 publications

(18 citation statements)

References 71 publications

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“…The local flap is the most used technique for the reconstruction of the nipple [ 5 , 8 , 14 , 15 , 16 , 17 ]. This is a skin flap that usually includes the local skin and the superficial layer of the underlying subcutaneous tissue.…”

Section: Nipple Reconstruction With Local Flapmentioning

confidence: 99%

“…Several techniques have been proposed for the reconstruction [ 4 , 5 , 6 , 7 , 14 , 15 , 16 , 17 , 18 ]. Some authors have attempted to clarify the available surgical techniques for nipple–areola complex reconstruction.…”

Section: Introductionmentioning

confidence: 99%

“…Some authors have attempted to clarify the available surgical techniques for nipple–areola complex reconstruction. The first was Farhadi et al [ 15 ] (Switzerland) in 2006, followed by Boccola et al [ 14 ] (Australia) in 2010, Nimboriboonporn and Chuthapisith [ 17 ] (Thailand) in 2014 and Sisti et al [ 5 ] (Italy) in 2016. In particular, Nimboriboonporn and Chuthapisith [ 17 ] proposed a first classification of nipple–areola reconstruction, according to the performed technique and to the type of material eventually grafted inside the neo-nipple.…”

Section: Introductionmentioning

confidence: 99%

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Nipple–Areola Complex Reconstruction

Sisti

2020

Medicina

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Section: Nipple Reconstruction With Local Flapmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Nipple–Areola Complex Reconstruction

Sisti

2020

Medicina

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“…Nipple-areola complex reconstruction (NAR) most commonly represents the finishing touch to post-oncologic breast reconstruction (BR) [1][2][3]. Despite being a minor procedure, it holds major significance to the patients [4], because of its impact on the overall appearance of the breast [5][6][7][8][9].…”

Section: Introductionmentioning

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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“…Local flaps have become the technique of choice for surgeons, as these methods are rapid, reliable, and eliminate the need for skin grafts, with their concomitant potential for donor site morbidity [7]. Examples of local tissue flaps are the bell flap, star flap, skate flap, tab flap, arrow flap, and C-V flap (composed of one C-shaped flap and two V-shaped flaps), all of which have numerous variations [1,3,[8][9][10][11][12][13][14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

The weave technique for nipple reconstruction

Kim

Gust

Connor

et al. 2013

Journal of Plastic Surgery and Hand Surgery

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Traditional nipple reconstruction relies on local flap techniques. However, there are several problems associated with local flap reconstruction including loss of projection, widening of the base width, and difficulty working around the mastectomy scar. This study presents a variation of traditional local flap nipple reconstruction, which is termed the weave technique. Rather than using two flaps to create base width, the weave technique uses one. By controlling the base width, this may serve to sustain long-term projection. Second, filling the inside of the nipple with the second flap may contribute to longer term projection. Because there is no third flap, it is easier to orient the nipple with respect to the mastectomy scar. To date, the senior author has used this method to reconstruct 55 nipples in 40 patients, with 415 days (range 191-733) mean follow-up time. This includes 45 (82%) nipple reconstructions after tissue expander-implant reconstruction. The use of this technique has produced excellent aesthetic results with nipple projection and site healing. The majority of patients have been satisfied with their nipple reconstruction. Three patients had wound healing difficulties, including two (3.6%) that healed with conservative wound care and one (1.8%) in a radiated patient requiring surgical revision. There were no other revisions necessary and no infections. In summary, the weave technique is a suitable modification to the popular C-V technique that maintains the benefits and simplicity of the aforementioned flap while potentially reducing projection loss, conserving base width, and allowing greater flexibility for nipple placement.

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Surgical Correction and Reconstruction of the Nipple-Areola Complex: Current Review of Techniques

Cited by 33 publications

References 71 publications

Nipple–Areola Complex Reconstruction

Nipple–Areola Complex Reconstruction

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

The weave technique for nipple reconstruction

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