Modified C-V flap for nipple reconstruction: our results in 50 patients.

Various techniques have been advocated for nipple reconstruction following mastectomy, including the C-V flap. In this study, we describe a modification of the C-V flap, and present results of our first 50 patients who have had nipple reconstruction using this modified technique. Assessments were made both subjectively through a questionnaire and objectively by using a calliper to measure nipple projection. Follow up ranged from 6 to 36 months (mean 15.4 months). Three (6%) patients suffered partial flap loss which settled with conservative treatment; one patient (2%) had complete flap loss due to infection and needed repeat reconstruction. Projection of the reconstructed nipples ranged between 0.5 and 4.99 mm (mean 2.17 mm). The difference in projection between the reconstructed and contralateral normal nipples ranged between -2 and 5.2 mm (mean 1.5 mm). Mean decrease in nipple projection was 45%. Fourteen (28%) patients reported some sensory recovery of their reconstructed nipples. Using a numerical scale of one to 10 (where one indicates worst, and 10 best possible outcomes), the reconstructed nipples were rated overall as good when compared to the opposite side [mean 6.5 (1-10)]. Patient satisfaction with this technique was rated as very good [mean 7.2 (1-10)]; and similarly improvement in body image as very good [mean 7.3 (1-10)]. The modified C-V flap in nipple reconstruction is simple, reliable, and offers an easy manoeuvre to provide connective tissue support for the reconstructed nipple. Moreover it produces good projection and has a high satisfaction rate and impact on enhancing patients' perception of body image. Video clips (1-6) are included with the paper for demonstration of the modified C-V flap technique.

Tattooing of the nipple-areola complex: review of outcome in 40 patients.

Reconstruction of a pigmented nipple-areola complex (NAC) is one of the final steps in rehabilitating patients following mastectomy. We report the results of 40 consecutive patients who had NAC tattooing done by the same surgeon. Assessments were made both subjectively using a questionnaire, and objectively by using a computer software programme (Adobe Photoshop) to analyse the colour of the NACs. Follow up ranged between six and 24 months (mean 14 months). One patient suffered an infection, and was the only one to need repeat tattooing in our series. Thirty-seven patients (92%) reported some colour fading which ranged between 5% and 80% (mean 32%). A grade of good or very good was given by 33 patients (82%) for colour match, by 36 patients (90%) for over all satisfaction, and by 34 patients (85%) for enhancement in body image. An analysis of the colours of the tattooed and unoperated NACs by the software programme showed that they were similar to a value that ranged from 78% to 97% (mean 91%). Tattooing is a simple and safe procedure, and despite some colour asymmetry it still has a high satisfaction rate. It significantly improves patient's perception of body image. An objective assessment of tattooing using a computer software programme can be a useful tool in reviewing the outcome. Video clips (1-5) are included with the paper for demonstration of the tattooing technique (re-arranged from the video presented with the paper at BAPS).

The use of the latissimus dorsi musculocutaneous flap for immediate correction of the deformity resulting from breast conservation surgery.

Breast conservation surgery is now widely accepted as the treatment of choice in early breast cancer. Randomised controlled trials have shown comparable recurrence and survival rates following breast conservation when compared to mastectomy, with the perceived advantage that it should leave a cosmetically acceptable result without reconstruction. It is our experience that an adequate local excision may result in a poor cosmetic result with distortion of the nipple position, especially in women with small breasts. Between January 1994 and July 1996, we have performed 30 procedures, combining a wide local excision and axillary lymph node clearance for breast cancer with immediate reconstruction of the defect with a latissimus dorsi musculocutaneous flap. All patients had postoperative radiotherapy to the residual breast and, where appropriate, to the axilla. Adjuvant hormonal therapy or chemotherapy was prescribed where indicated. Patient's ages ranged from 36 to 72 years. All tumours were in the lateral, superior or inferior quadrants. The mean combined operating time was 120 min. Two patients required postoperative blood transfusion. Mean hospital stay was 8 days. Histology confirmed tumour clearance in all cases and six patients had axillary lymph node metastases. There were two cases of minor wound infection and six cases of seroma at the donor site. We conclude that breast cancers are ideally treated by a multidisciplinary team and that an immediate latissimus dorsi musculocutaneous flap may correct the deformities often seen after breast conservation surgery.