How to Improve Projection in Nipple Reconstruction: A Modified Method Using Acellular Dermal Matrix Disk and Fragments

Abstract

Background: Nipple reconstruction is an essential, final stage in breast reconstruction. However, postoperative reduction in nipple projection often results in low patient satisfaction. The authors studied the causes of the projection decline and developed a new method using acellular dermal matrix. This research studies the effectiveness of the new method. Methods: The nipple flap was elevated using a modified C-V flap, and acellular dermal matrix disk was fixed onto the floor. A column was made, into which acellular dermal matrix fragments were put in to retain the projection. The footprint diameter and projection at 1 year were compared with those of the control group, in which acellular dermal matrix was not used. The authors studied the correlation between diameter and projection and whether reconstruction method caused any impact. Results: At 1-year follow-up, the nipple diameter and projection in the acellular dermal matrix group were measured to be 102.90 percent and 64.19 percent, respectively, of the baseline. Compared with the control group, the diameter was significantly smaller (p = 0.00) and the projection was higher (p = 0.00). A significant correlation was identified between nipple diameters and projections, at 1-year follow-up, across the total 90 reconstructed nipples (p = 0.00). Different reconstruction methods did not show significant differences in terms of nipple diameter and projection, but the projections at 1 year were highest in the latissimus dorsi flap plus implant group, followed by the expander group and the transverse rectus abdominis musculocutaneous flap group. Conclusion: Nipple reconstruction using acellular dermal matrix disk and fragments prevents downward shifting of the nipple tissue and broadening of the footprint diameter and thus is favorable for long-term maintenance of nipple projection.

3D Printing Breast Tissue Models: A Review of Past Work and Directions for Future Work

“…Recreating the nipple-areola complex during breast reconstruction has been challenging. Studies show that nipple recreation is highly correlated with patient satisfaction and body image after breast reconstruction [53]. Current techniques, including local flaps, and pigmented skin grafts have unpredictable long-term outcomes in terms of neo-nipple projection, color, size, shape and texture, and the advantages of a 3D-bioprinted nipple areola complex have been suggested [31,54,55].…”

Staged Immediate Nipple Reconstruction With Tube Flap in Immediate Deep Inferior Epigastric Artery Perforator Flap Breast Reconstruction

“…Then side part of the new nipple migrates in a centrifugal direction to offset the widening compromise. 9,10,12 The increase of the nipple footprint diameter is supposed to be the major cause of the projection reduction. Here in our tube flap method, the reconstructed breast mound need not be disturbed.…”

“…However, loss of projection of the reconstructed nipple over time is one of the major problems. This could be explained by many factors, such as a lack of structural soft tissue support within or at the base of the flap, widening of the nipple footprint, fat atrophy, scar contraction, delayed wound healing or infection, inelastic irradiated skin, and external pressures 9,10 . Numerous modifications have been proposed to limit loss of projection by making a considerable initial hypercorrection, thus leading to more soft tissue volume loss and distortion.…”

“…Third, it has been reported that, in local flap nipple reconstruction, the dermis structure at the base of the nipple is undermined, and the dermal continuity is compromised, then the tension of the nipple base becomes weaker than its surrounding areas, and the surface of the undermined area is widened with time. Then side part of the new nipple migrates in a centrifugal direction to offset the widening compromise 9,10,12 . The increase of the nipple footprint diameter is supposed to be the major cause of the projection reduction.…”