Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
권호 표지
DOI QR코드

DOI QR Code

De-epithelialized dermal flap for nipple reconstruction: A modified star flap

  • Lee, Su Hyun (Department of Plastic and Reconstructive Surgery, Korea University Ansan Hospital) ;
  • Kim, Deok Woo (Department of Plastic and Reconstructive Surgery, Korea University Ansan Hospital) ;
  • You, Hi Jin (Department of Plastic and Reconstructive Surgery, Korea University Ansan Hospital) ;
  • Jung, Jae A (Department of Plastic and Reconstructive Surgery, Korea University Ansan Hospital) ;
  • Hwang, Na Hyun (Department of Plastic and Reconstructive Surgery, Korea University Ansan Hospital) ;
  • You, Jae Pil (Department of Plastic and Reconstructive Surgery, Korea University Ansan Hospital) ;
  • Yoon, Eul Sik (Department of Plastic and Reconstructive Surgery, Korea University Anam Hospital)
  • Received : 2018.08.25
  • Accepted : 2019.05.29
  • Published : 2019.07.15
Download PDF
⟨ Previous Next ⟩

Abstract

Background Multiple approaches for nipple reconstruction exist, and none is considered superior to all others. The star flap is one of the most popular methods for nipple reconstruction, but gradual height loss is a major concern. We present a new modification of the star flap that incorporates a de-epithelialized dermal flap, along with the associated surgical results. Methods We reviewed the medical records of patients who underwent nipple reconstruction using the modified star flap method. The design was different from the conventional star flap in that the lateral wings were changed into a trapezoidal shape and de-epithelialized dermal flaps were added. The patients were followed up at 2, 4, 6, and 12 months postoperatively, and nipple height was measured. The postoperative nipple height achieved using the modified method was compared with that obtained using the traditional method. Results From February 2013 to June 2017, 32 patients received surgery using the modified star flap, and 18 patients who underwent nipple reconstruction before 2013 comprised the conventional method group. All patients had undergone breast reconstruction with an abdominal tissue-based flap. The mean follow-up period was 14.4 months in the modified method group and 17.3 months in the conventional method group. The mean maintenance of projection at 12 months postoperatively was $56.28%{\pm}18.58%$ in the modified method group, and $44.23%{\pm}14.15%$ in the conventional method group. This difference was statistically significant (P<0.05). Conclusions The modified method using a de-epithelialized dermal flap provides reliable maintenance of projection in patients who have undergone abdominal tissue-based breast reconstruction.

Keywords

References

  1. Momoh AO, Colakoglu S, de Blacam C, et al. The impact of nipple reconstruction on patient satisfaction in breast reconstruction. Ann Plast Surg 2012;69:389-93. https://doi.org/10.1097/SAP.0b013e318246e572
  2. Anton MA, Eskenazi LB, Hartrampf CR Jr. Nipple reconstruction with local flaps: star and wrap flaps. Perspect Plast Surg 1991;5:68-78.
  3. Bramhall RJ, Thiruchelvam PT, Concepcion M, et al. Use of acellular dermal matrix (ADM) in nipple reconstruction: the 'central-pillar technique'. Gland Surg 2017;6:394-8. https://doi.org/10.21037/gs.2017.03.13
  4. Weissler EH, Schnur JB, Lamelas AM, et al. The necessity of the nipple: redefining completeness in breast reconstruction. Ann Plast Surg 2017;78:646-50. https://doi.org/10.1097/SAP.0000000000000943
  5. Jabor MA, Shayani P, Collins DR Jr, et al. Nipple-areola reconstruction: satisfaction and clinical determinants. Plast Reconstr Surg 2002;110:457-63. https://doi.org/10.1097/00006534-200208000-00013
  6. Nimboriboonporn A, Chuthapisith S. Nipple-areola complex reconstruction. Gland Surg 2014;3:35-42.
  7. Saleh DB, Mohammed PD. The double-breasted dermal flap in nipple reconstruction. J Reconstr Microsurg 2013;29: 421-2. https://doi.org/10.1055/s-0033-1343949
  8. Temiz G, Yesiloglu N, Sirinoglu H, et al. A new modification of C-V flap technique in nipple reconstruction: rolled triangular dermal-fat flaps. Aesthetic Plast Surg 2015;39:173-5. https://doi.org/10.1007/s00266-014-0422-3
  9. Crichton ML, Donose BC, Chen X, et al. The viscoelastic, hyperelastic and scale dependent behaviour of freshly excised individual skin layers. Biomaterials 2011;32:4670-81. https://doi.org/10.1016/j.biomaterials.2011.03.012
  10. Whitton JT, Everall JD. The thickness of the epidermis. Br J Dermatol 1973;89:467-76. https://doi.org/10.1111/j.1365-2133.1973.tb03007.x
  11. Park GY, Yoon ES, Cho HE, et al. Acellular dermal matrix as a core strut for projection in nipple reconstruction: approaches for three different methods of breast reconstruction. Arch Plast Surg 2016;43:424-9. https://doi.org/10.5999/aps.2016.43.5.424
  12. Rao SS, Seaman BJ, Davison SP. The acellular dermal matrix onlay graft for areolar reconstruction. Ann Plast Surg 2014; 72:508-12. https://doi.org/10.1097/SAP.0b013e318268a83d
  13. Lee JH, Kim HG, Lee WJ. Characterization and tissue incorporation of cross-linked human acellular dermal matrix. Biomaterials 2015;44:195-205. https://doi.org/10.1016/j.biomaterials.2014.12.004
  14. Winocour S, Saksena A, Oh C, et al. A systematic review of comparison of autologous, allogeneic, and synthetic augmentation grafts in nipple reconstruction. Plast Reconstr Surg 2016;137:14e-23e. https://doi.org/10.1097/PRS.0000000000001861
  15. Krishnan NM, Chatterjee A, Van Vliet MM, et al. A comparison of acellular dermal matrix to autologous dermal flaps in single-stage, implant-based immediate breast reconstruction: a cost-effectiveness analysis. Plast Reconstr Surg 2013;131: 953-61. https://doi.org/10.1097/PRS.0b013e3182865a24