Download PDF
CC BY-NC 4.0 · Arch Plast Surg 2012; 39(04): 384-389
DOI: 10.5999/aps.2012.39.4.384
Original Article

Reducing Donor Site Morbidity When Reconstructing the Nipple Using a Composite Nipple Graft

Taik Jong Lee
Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
,
Hyung Joo Noh
Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
,
Eun Key Kim
Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
,
Jin Sup Eom
Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
› Author Affiliations
› Further Information
   Permissions and Reprints

Background Numerous procedures are available for nipple reconstruction without a single gold standard. This study presents a method for reducing donor-site morbidity in nipple reconstruction using a composite nipple graft after transverse rectus abdominis musculocutaneous flap breast reconstruction.

Methods Thirty-five patients who underwent nipple reconstruction using a composite nipple graft technique between July of 2001 and December of 2009 were enrolled in this study. To reduce the donor site morbidity, the superior or superior-medial half dome harvesting technique was applied preserving the lateral cutaneous branch of the fourth intercostal nerves. The patients were asked to complete a previously validated survey to rate the color and projection of both nipples, along with the sensation and contractility of the donor nipple; and whether, in retrospect, they would undergo the procedure again. To compare projection, we performed a retrospective chart review of all the identifiable patients who underwent nipple reconstruction using the modified top hat flap technique by the same surgeon and during the same period.

Results Thirty-five patients were identified who underwent nipple reconstruction using a composite nipple graft. Of those, 29 patients (82.9%) responded to the survey. Overall, we received favorable responses to the donor site morbidity. Projection at postoperative 6 months and 1 year was compared with the immediate postoperative results, as well as with the results of nipples reconstructed using the modified top hat flap.

Conclusions The technique used to harvest donor tissue is important. Preserving innervation of the nipple while harvesting can reduce donor site morbidity.

Keywords

Morbidity - Nipples - Reconstructive surgical procedures

This article was presented at the the 69th Annual Conference of the Korean Society of Plastic and Reconstructive Surgeons on November 11-13, 2011 in Seoul, Korea.




Publication History

Received: 05 April 2012

Accepted: 31 May 2012

Article published online:
01 May 2022

© 2012. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • REFERENCES

  • 1 Wellisch DK, Schain WS, Noone RB. et al. The psychological contribution of nipple addition in breast reconstruction. Plast Reconstr Surg 1987; 80: 699-704
    CrossrefPubMedGoogle Scholar
  • 2 Asplund O. Nipple and areola reconstruction. A study in 79 mastectomized women. Scand J Plast Reconstr Surg 1983; 17: 233-240
    Google Scholar
  • 3 Gruber RP. Nipple-areola reconstruction: a review of techniques. Clin Plast Surg 1979; 6: 71-83
    CrossrefPubMedGoogle Scholar
  • 4 Losken A, Mackay GJ, Bostwick J. Nipple reconstruction using the C-V flap technique: a long-term evaluation. Plast Reconstr Surg 2001; 108: 361-369
    CrossrefPubMedGoogle Scholar
  • 5 Weiss J, Herman O, Rosenberg L. et al. The S nipple-areola reconstruction. Plast Reconstr Surg 1989; 83: 904-906
    CrossrefPubMedGoogle Scholar
  • 6 Eng JS. Bell flap nipple reconstruction: a new wrinkle. Ann Plast Surg 1996; 36: 485-488
    CrossrefPubMedGoogle Scholar
  • 7 Tanabe HY, Tai Y, Kiyokawa K. et al. Nipple-areola reconstruction with a dermal-fat flap and rolled auricular cartilage. Plast Reconstr Surg 1997; 100: 431-438
    CrossrefPubMedGoogle Scholar
  • 8 Chang WH. Nipple reconstruction with a T flap. Plast Reconstr Surg 1984; 73: 140-143
    CrossrefPubMedGoogle Scholar
  • 9 Anton M, Eskenazi LB, Hartrampf CR. Nipple reconstruction with local flaps: star and wrap around flaps. Perspect Plast Surg 1991; 5: 67-78
    Google Scholar
  • 10 Kroll SS. Nipple reconstruction with the double-opposing tab flap. Plast Reconstr Surg 1999; 104: 511-514
    CrossrefPubMedGoogle Scholar
  • 11 Little JW, Spear S. Nipple-areolar reconstruction. Perspect Plast Surg 1988; 2: 1-12
    Google Scholar
  • 12 Brent B, Bostwick J. Nipple-areola reconstruction with auricular tissues. Plast Reconstr Surg 1977; 60: 353-361
    PubMedGoogle Scholar
  • 13 Hallock GG. Polyurethane nipple prosthesis. Ann Plast Surg 1990; 24: 80-85
    CrossrefPubMedGoogle Scholar
  • 14 Cao YL, Lach E, Kim TH. et al. Tissue-engineered nipple reconstruction. Plast Reconstr Surg 1998; 102: 2293-2298
    CrossrefPubMedGoogle Scholar
  • 15 Few JW, Marcus JR, Casas LA. et al. Long-term predictable nipple projection following reconstruction. Plast Reconstr Surg 1999; 104: 1321-1324
    CrossrefPubMedGoogle Scholar
  • 16 Shestak KC, Gabriel A, Landecker A. et al. Assessment of long-term nipple projection: a comparison of three techniques. Plast Reconstr Surg 2002; 110: 780-786
    CrossrefPubMedGoogle Scholar
  • 17 Pusic AL, Klassen AF, Scott AM. et al. Development of a new patient-reported outcome measure for breast surgery: the BREAST-Q. Plast Reconstr Surg 2009; 124: 345-353
    CrossrefPubMedGoogle Scholar
  • 18 Cheng MH, Ho-Asjoe M, Wei FC. et al. Nipple reconstruction in Asian females using banked cartilage graft and modified top hat flap. Br J Plast Surg 2003; 56: 692-694
    CrossrefPubMedGoogle Scholar
  • 19 Hamori CA, LaRossa D. The top hat flap: for one stage reconstruction of a prominent nipple. Aesthetic Plast Surg 1998; 22: 142-144
    CrossrefPubMedGoogle Scholar
  • 20 Cheng MH, Rodriguez ED, Smartt JM. et al. Nipple reconstruction using the modified top hat flap with banked costal cartilage graft: long-term follow-up in 58 patients. Ann Plast Surg 2007; 59: 621-628
    CrossrefPubMedGoogle Scholar
  • 21 Spear SL, Schaffner AD, Jespersen MR. et al. Donor-site morbidity and patient satisfaction using a composite nipple graft for unilateral nipple reconstruction in the radiated and nonradiated breast. Plast Reconstr Surg 2011; 127: 1437-1446
    CrossrefPubMedGoogle Scholar
  • 22 Sarhadi NS, Shaw Dunn J, Lee FD. et al. An anatomical study of the nerve supply of the breast, including the nipple and areola. Br J Plast Surg 1996; 49: 156-164
    CrossrefPubMedGoogle Scholar
  • 23 Jaspars JJ, Posma AN, van Immerseel AA. et al. The cutaneous innervation of the female breast and nipple-areola complex: implications for surgery. Br J Plast Surg 1997; 50: 249-259
    CrossrefPubMedGoogle Scholar
  • 24 Farina MA, Newby BG, Alani HM. Innervation of the nipple-areola complex. Plast Reconstr Surg 1980; 66: 497-501
    CrossrefPubMedGoogle Scholar
  • 25 Lee JH, Yang JD, Chung KH. et al. Anthropometric measurement for the nipple areola complex. J Korean Soc Plast Reconstr Surg 2008; 35: 461-464
    Google Scholar