Incorporation of a Preexisting Scar in the Star-Flap Technique for Nipple Reconstruction

Gürünlüoğlu, Raffi; Shafighi, Maziar; Williams, Susan A.; Kimm, G. Edward

doi:10.1097/sap.0b013e318214e6ba

Cited by 10 publications

(5 citation statements)

References 20 publications

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“…The use of avascular scar tissue as a free graft harvested from a linear fragment of mastectomy scar, in combination with the healthy skin of a local flap, has been already proposed [10]. Nevertheless, the use of an adjacent mastectomy preexisting scar as donor-site for flaps harvesting has been avoided for many years due to the fear of flap ischemia and necrosis [11,12].…”

Section: Discussionmentioning

confidence: 99%

“…Lesavoy and Liu [11] described in 2010 the diamond double-opposing V-Y flap; this reliable technique showed good results allowing the incorporation of prior mastectomy scars into the flap limbs if they are in the appropriate location. Gurunluoglu et al [12] described in 2012 a star flap technique incorporating a previous scar, and no significant vascular compromise was reported, with acceptable nipple projection and volume. Riccio et al [13] reported in 2015 a V-Y advancement flap which incorporates a previous wise pattern mastectomy or mammaplasty scar into the newly reconstructed nipple, thereby decreasing new scar formation on the breast and leading to favorable cosmetic result.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

A Simple and Reliable Method of Nipple Reconstruction Using a Spiral Flap Made of Residual Scar Tissue

Torresetti

Scalise

Benedetto

2017

Nipple-Areolar Complex Reconstruction

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A Simple and Reliable Method of Nipple Reconstruction Using a Spiral Flap Made of Residual Scar Tissue

Torresetti

Scalise

Benedetto

2017

Nipple-Areolar Complex Reconstruction

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“…Most reconstructed nipples retract over time due to scarring and scar contraction, particularly when there has been previous radiotherapy, infection, or poor flap design that compromises the circulation and delays healing. Well established flaps include the skate, 9 star, 10 double-opposing tab flap, 11 - 13 double opposing V-Y flap, 14 and the V-Y advancement flap. 15 …”

Section: Discussionmentioning

confidence: 99%

Nipple Reconstruction Using the C-v Flap Technique: Long-Term Outcomes

Jalini¹,

Lund²,

Kurup³

2016

IJSM

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BACKGROUNDNipple creation using the C-V flap technique is often the final step in breast reconstruction. The aim of this study was to subjectively and objectively assess the cosmetic outcomes and satisfaction of patients undergoing C-V flap nipple reconstruction.METHODSSubjective assessments of patient satisfaction with the neo-nipple were recorded by visual analogue scoring (VAS; 0-10). Objective measurements were performed using a calliper to measure nipple projection relative to the native breast. Descriptive data analysis was performed with differences in projection assessed with the Mann-Whitney test and mean and median VAS scores (with inter-quartile ranges; IQR) calculated to describe satisfaction.RESULTSThirty-three C-V flap nipple reconstructions were performed. 87.9% received latissimus dorsi (LD) reconstructions with implants and 12.1% had transverse rectus abdominis muscle (TRAM) reconstructions. The median projection of reconstructed nipples was 4.7 mm (range 4-10.2 mm) at 4.6 years mean follow-up, which was not significantly different from the contralateral nipple (p = 0.34). Patient satisfaction was 9 (IQR: 8-10) with shape, 9 (IQR: 7.5-10) with projection, 5 (IQR: 2-9.6) with sensation, and 8.5 (IQR: 6-9.5) with symmetry. Median overall satisfaction was 9 (IQR: 8-10). Three patients had complete nipple loss, of whom two had undergone nipple piercing post procedure and none had received radiotherapy.CONCLUSIONC-V flap nipple reconstructions provide a simple and reliable method to reconstruct the nipple that enhances confidence and perception of body image. Satisfaction was high with long-term outcomes in terms of projection equivalent to the contralateral breast.

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“…Clinically, it has been reported that the use of flaps elevated from the abdomen with a preexisting scar in the midline and subsequent use in breast reconstruction increased the necrosis rates [ 10 – 12 ]. In addition, no vascular problem was observed in nipple reconstruction techniques in which the mastectomy scar was included [ 13 ]. Although these studies provide very valuable information, the reliability of standard flaps planned from tissues that have experienced recent trauma or in which there was a scar in the midline was not evaluated.…”

Section: Introductionmentioning

confidence: 99%

Effects of different scar types on flap viability in a skin flap model: an experimental study

UZUN¹,

DEMİR²,

YAŞAR³

et al. 2022

Turkish Journal of Medical Sciences

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Background/aim The purpose of this study was to investigate the use of tissues with multiple traumas, scarred pedicles, and medial scarring as a flap. Materials and methods Forty-eight rats were randomly divided into four equal groups. The modified McFarlane flap was chosen as the flap model. In Group 1 (control), a dorsal skin flap was elevated and then sutured back into original position. In the other groups, a two-phase procedure was used. In Group 2 (pedicle incision), scar tissue was created with a skin incision at the prospective pedicle site of the flap and then sutured to its original site. In Group 3 (preconditioning), multiple full-thickness traumas were performed along the entire flap body, and in Group 4 (middle incision) scar tissue was created with a skin incision at the prospective middle region of the flap. Then, after 45 days, dorsal flaps were raised in all rats and then sutured back into position. Seven days later, flap survival was evaluated through microangiography and histological evaluation of flap segments. Histopathological examination included assessment of the number of vessels, necrosis, infiltration with polymorphonuclear leukocytes, edema, fibrosis, inflammation, increase in fibroblast activity, and neovascularization. Results The flap survival rates were 66.78% in Group 1, 68.05% in Group 2, 68.5% in Group 3, and 60.01% in Group 4. The flap survival rate was significantly lower in Group 4 (p < 0.05). There was no significant difference in flap survival between Groups 1, 2, and 3. On microangiographic examination, the vascular network extended more distally and was densest around the scar line in Group 2. Vascularization was poorest in Group 4. On histological examination, the number of vessels tended to be greatest in Groups 3 and 4 but this was not significantly different between groups (p < 0.05). Conclusion The study findings showed that it may be possible to raise a flap from a previously mutilated site secondary to scar formation and multiple full-thickness traumas along the flap body. However, distal necrosis may occur in situations when the scar is positioned in the middle region of the prospective flap.

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Incorporation of a Preexisting Scar in the Star-Flap Technique for Nipple Reconstruction

Cited by 10 publications

References 20 publications

A Simple and Reliable Method of Nipple Reconstruction Using a Spiral Flap Made of Residual Scar Tissue

A Simple and Reliable Method of Nipple Reconstruction Using a Spiral Flap Made of Residual Scar Tissue

Nipple Reconstruction Using the C-v Flap Technique: Long-Term Outcomes

Effects of different scar types on flap viability in a skin flap model: an experimental study

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