Correction of Inverted Nipple Using Modified Teimourian Method

Inversion of nipple is a common condition occurring with an incidence of 2% in women. It not only causes irritation and inflammation, but also causes aesthetic problems, affecting sexual relationships and psychological well-being of the patients. Several methods have been introduced to treat this condition in the past century, but the major principle of correction is based on the concept suggested by Schwager, that inverted nipple develops because of the lack of connective tissue located directly beneath the nipple. Based on this concept, many surgeons including Broadbent, Teimourian, and Elshy etc. have proposed that adding bulk of connective tissue and scarifing the ductal system is the principle of the treatment. Author`s method is also based on such a concept, and we have modified the Teimourian method. First, an intraglandular section in the shape of an inverted cone was performed. The crator-like glandular section was closed using horizontal mattress suture, leading to circumglandular V-Y advancement. Second, the donor sites on the areolar area were closed with V-Y advancement. Third, purse-string suture was performed to achieve neck tightening and to compensate for the lack of connective tissue beneath the nipple. Dermal flap suture was done by Foot-plate manner. We operated on 52 cases using this method, 28 patients during past 2 years. After 1 year following the operation, there were just two cases of relapse and virtually no complications. We obtained satisfactory projection of the nipples in all patients except in 2 cases. The resulting shapes and scars were acceptable to all patients.

Breast Reconstruction Using Bipedicled free TRAM in Patients with Subumbilical Vertical Midline Scar

Breast reconstruction using TRAM flap after mastectomy has been widely adopted and regarded as a gold standard method. In patients with the abdominal midline scar, insufficient blood circulation to regions contralateral to the pedicle disables inclusion of them in the TRAM flap design. So modifications including Double- pedicled TRAM, Super-charged, Turbo-charged, Bipedicled free TRAM et al. have been attempted to resolve the problem of circulatory interruption by midline scar. The authors designed a new bipedicled free TRAM flap to avoid limitations like epigastric buldging, significant abdominal weakness and complexity of flap insetting. The two donor arteries(right and left deep inferior epigastric arteries) are anastomosed to the proximal and distal ends of divided internal mammary arteries using the reverse flow. Vein anastomoses were performed in the same manner through the divided venae comitantes. Two patients having infraumbilical midline scar underwent breast reconstruction using author`s new flap. Flaps survived without fat necrosis or partial flap loss in both patients and their results in aesthetic aspects were very satisfactory. Compared to previous method for breast reconstruction of patients having infraumbilical midline scar, author's new method is useful and effective in terms of the aesthetic and technical aspect.