ABSTRACT
Objective To discuss the reasons of iatrogenic nipple-areola necrosis and to investigate clinical effect of nipple-areola reconstruction by three-bladed flap combined with free skin graft.Methods Between May 2012 and May 2015,13 patients with nipple-areola necrosis caused by iatrogenic reasons were treated with our new method.We designed a skate flap on the new nipple site.After incising skin,three-bladed flap was cross-stitched to form a new nipple.New areola was reconstructed by free skin graft,which was obtained from perineum or contralateral areola,and margin of the donor area was sutured after proper free from surrounding tissues.Being deducted subcutaneous tissue,the full-thickness skin graft was sutured around the nipple just like letter O.After operation,the areola area was pressurized bandaging,and the nipple was drawn by silk at least one month.Results The incisions were all primary healing.Over a mean period of 8 months (range 6-18),all patients were satisfied with the results.No significant asymmetry occured.The average nipple retraction rate was 10.03％.In 13 patients,there was no infection,bleeding or hematoma and skin flap necrosis.Conclusions Nipple-areola necrosis occurs when the blood supply is not protected carefully during a breast plastic surgery.Therefore,we take full advantage of the scar tissue which has hyperpigmentation.Reconstructive nipple-areola complex has good shape,and there is no need to tattoo after operation.
ABSTRACT
PURPOSE: A number of flap for nipple reconstruction have been well described in the literature. However, most of these techniques do not permit the reconstruction of a projecting nipple and all are hampered to some extent by long-term loss of nipple projection. The objective of this study is to evaluate the long-term result and clinical efficacy of nipple reconstruction using skate flap technique after breast reconstruction. METHODS: A retrospective chart review was carried out on 23 patients who underwent 25 nipple reconstructions. In those patients with greater than 10 mm nipple projection, reconstruction with skate flap and full-thickness skin graft and/or tattooing was performed. Maintenance of nipple projection was then carefully assessed over one-year follow-up. The following factors were analyzed: type of breast reconstruction, type of areola reconstruction, follow-up period, decrease in nipple projection, complication, and whether secondary nipple reconstruction was necessary and/or performed. RESULTS: Breast reconstructions were performed in 17 patients with free transverse rectus abdominis musculocutaneous flap, 3 patients with extended latissimus dorsi musculocutaneous flap, and 3 patients with expander and implant. The mean follow-up after nipple reconstruction was 17 months. Mean loss of projection were 17.0 +/- 13.99%, 25.0 +/- 12.70%, 30.0 +/- 12.57% and 30.8 +/- 12.49% at 3, 6, 9 months and over one year, respectively. The greatest decrease in projection was noted in the first 3 months following surgery. CONCLUSION: These results indicated that nipple reconstruction with skate flap showed about 70 percent of the projection achieved over one year postoperation. Therefore, the skate flap may be a reliable method of nipple reconstruction in those patients with greater than 10 mm nipple projection.