Safe delayed procedure of nipple reconstruction in poorly circulated nipple

Lee, Joon Seok; Eom, Jeung Ryeol; Lee, Jeong Woo; Choi, Kang Young; Cho, Byung Chae; Yang, Jung Dug

doi:10.1111/tbj.13167

Cited by 3 publications

(2 citation statements)

References 18 publications

(55 reference statements)

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“…We propose that this bipedicled-flap technique enables nipple reconstruction in a broad range from a narrow, high nipple to a wide, low nipple. A single random pedicled skin flap supplies 2-3 flap tips in representative techniques and its variables, resulting in many reports of tissue loss owing to focal ischemia (35). The bipedicled flap reconstruction resolves these complications considerably with reliable aesthetic outcomes and less projection reduction (Figures 6,7).…”

Section: Discussionmentioning

confidence: 99%

Simultaneous nipple reconstruction in autologous breast reconstruction

Lee¹,

Ryu²,

Lee³

et al. 2021

Gland Surg

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Background: Reconstruction of the nipple-areola complex is the final step in surgical restoration of the breast. Nipple-areola reconstruction was previously done after an interval of several months using variable techniques, often resulting in low projection and flattened breast mound over time. We present algorithm of simultaneous nipple reconstruction (SNR) that leaves adequate residual projection and naturally shaped breast mound.Methods: Forty patients underwent a skin-sparing mastectomy and nipple excision between October 2016 and December 2020. In the control group, 21 patients underwent delayed nipple reconstruction for 6 months after breast reconstruction. The experimental group of 19 patients underwent nipple and breast reconstruction simultaneously. We collected relevant information and photographs of nipple profiles of both groups in the preoperative, postoperative 6-month, and postoperative 1-year time periods. We also examined the ratio between the reconstructed and contralateral nipples.Results: Scores regarding patient satisfaction questionnaire averaged higher in experimental groups to every category. The control group's scores gradually declined over time and the experimental group showed lesser decline. At the 1-year postoperative follow-up, the mean projection of the immediately reconstructed nipple was approximately the same as the contralateral nipple at 91%, whereas the delayed reconstructed nipple resulted in a 77% ratio.Conclusions: Nipple reconstruction should no longer be considered as a secondary complement to immediate breast reconstruction. The nipple appears to be essential component of breast reconstruction for patient. SNR with immediate breast reconstruction is a simple and reliable technique, giving stable aesthetic results over time.

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Section: Discussionmentioning

confidence: 99%

Simultaneous nipple reconstruction in autologous breast reconstruction

Lee¹,

Ryu²,

Lee³

et al. 2021

Gland Surg

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“…We found just two algorithms in the literature that described recommendations on how to approach NAR. Lee et al introduced the Kyungpook National University Hospital (KNUH) algorithm in 2019 [ 94 ]. It is based on the experience that the authors developed following a study on 21 patients who underwent implant-based BR and NAR using C-V or Hammond flap and that were followed-up for 12 months to assess results.…”

Section: Discussionmentioning

confidence: 99%

Guiding Nipple-Areola Complex Reconstruction: Literature Review and Proposal of a New Decision-Making Algorithm

et al. 2020

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Background Nipple-areola complex reconstruction (NAR) most commonly represents the finishing touch to breast reconstruction (BR). Nipple presence is particularly relevant to the patient’s psyche, beyond any shadow of doubt. Many reconstructive options have been described in time. Surgery is easy, but final result is often disappointing on the long run. Methods The goal of this manuscript is to analyze and classify knowledge concerning NAR techniques and the factors that influence success, and then to elaborate a practical evidence-based algorithm. Out of the 3136 available articles as of August 8th, 2020, we selected 172 manuscripts that met inclusion criteria, which we subdivided into 5 main topics of discussion, being the various NAR techniques; patient factors (including patient selection, timing and ideal position); dressings; potential complications and finally, outcomes/patient satisfaction. Results We found 92 articles describing NAR techniques, 41 addressing patient factors (out of which 17 discussed patient selection, 14 described ideal NAC location, 10 described appropriate timing), 10 comparing dressings, 7 studying NAR complications, and 22 addressing outcomes and patient satisfaction. We elaborated a comprehensive decision-making algorithm to help narrow down the choice among NAR techniques, and choose the correct strategy according to the various scenarios, and particularly the BR technique and skin envelope. Conclusions No single NAR technique provides definitive results, which is why we believe there is no “end-all be-all solution”. NAR must be approached as a case-by-case situation. Furthermore, despite NAR being such a widely discussed topic in scientific literature, we still found a lack of clinical trials to allow for more thorough recommendations to be elaborated. Level of Evidence III This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266

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