• Archives of Plastic Surgery
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• v.41 no.2
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• pp.158-162
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• 2014

Background Loss of nipple projection is a common problem following nipple reconstruction. The aim of this study was to demonstrate that the use of a tightly rolled dermal graft is effective in the long-term maintenance of nipple projection. Methods Nipple reconstruction was performed using the C-V flap technique. A dermal graft was harvested from the dog-ear portion of previous scars. The graft was rolled tightly into a compact cylinder and used to augment the nipple reconstruction. Postoperatively, stacked Allevyn dressing was used for protecting the nipple from compression for a minimum of two months. Nipple projection was measured at the time of surgery and at 12 months postoperatively. Results Forty nipple reconstructions were performed using this technique. There were 19 transverse rectus abdominis musculocutaneous (TRAM) flaps, 10 latissimus dorsi (LD) flaps, and 11 tissue-expanded breast mounds. At one year, the mean projection was 0.80 cm (range, 0.62-1.22 cm). The twelve-month average maintenance of nipple projection was 70.2% for the TRAM flap group, 76.3% for the LD flap group, and 61.8% for the tissue-expanded group. In two patients with previous irradiation of the reconstructed breasts, relatively poor maintenance of nipple projection was noted (45.7%). No complications were noted, and all of the donor sites healed well primarily. Conclusions Our results demonstrated that the use of a C-V flap with a tightly rolled dermal graft for nipple reconstruction improves the long-term maintenance of nipple projection. Its advantages include reproducibility, technical simplicity, cost-effectiveness, and minimal donor site morbidity.

• Archives of Plastic Surgery
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• v.44 no.5
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• pp.449-452
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• 2017

The nipple-sharing technique for nipple reconstruction offers excellent tissue matching. The method used for nipple graft harvesting determines the quality of the graft and hence, the success of nipple sharing. Here, we described a guillotine technique wherein the nipple is first transfixed with 2 straight needles to stabilise it. Two No. 11 blades are then inserted in the center and simultaneously swept outwards to amputate the distal portion of the nipple. This technique provides good control, resulting in a very evenly cut base. The recipient bed is deepithelialized thinly, and the nipple graft is inset with interrupted 8-0 nylon sutures under magnification. Being a composite graft, it is protected with splint dressings for 6 weeks, and the dressing is regularly changed by the surgeon. The height of the nipple grafts ranges from 4 to 8 mm. This technique was performed in 9 patients with an average follow-up of 2.9 years (range, 1-4.5 years). Apposition between the nipple graft and its bed is crucial for the success of this technique. When correctly applied, we observed rapid revascularization of the graft.

• Archives of Plastic Surgery
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• v.36 no.6
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• pp.779-783
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• 2009

Purpose: Male hypertrophic nipples can lead to psychological distress and physical discomfort. The authors present a new technique of male nipple reduction and describe its advantages Methods: The neonipple is designed to reduce diameter and height of nipple while preserving the subdermal plexus. After the central wedge excision, additional four triangular section of nipple skin is excised. One of the remaining two flaps is amputated partially and both flaps were approximated using 4 - 0 PDS and 6 - 0 Nylon sutures. Results: Between December of 2007 and January of 2009, 52 nipple reductions were performed in 30 male patients(mean = 29.5 years). Postoperative recovery was rapid and few complications were encountered. The mean diameter of the hypertrophic nipple was $9.1{\pm}2.5mm$(range, 7 to 15 mm). The mean diameter of the neonipple was $5.0{\pm}0.7mm$(range, 4 to 6 mm), with an average reduction of $3.8{\pm}0.6mm$(range, 2 to 11 mm). At follow-up, the neonipple had a natural appearance, with less projection and an inconspicuous scar. Conclusion: The wedge and triangular skin excision and partial amputation are easy to perform and yields consistent results. This technique decreases both the diameter and height of any size nipple and can be modified to meet patient preferences.

• Archives of Plastic Surgery
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• v.33 no.1
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• pp.101-106
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• 2006

Nipple reconstruction is an important step in breast reconstruction after mastectomy. The authors' preferred reconstructive technique is the local C-V flap in case that a small opposite nipple is not adequate for composite graft. This flap produces an excellent reconstruction, but it is not easy to produce an adequate projection and firmness of the nipple. This article describes the technique and experience in nine patients treated over two years with dermis(scar tissue) graft for nipple reconstruction. This is the first report of application of autologous dermis(scar tissue) grafting to reconstruct a nipple primarily after breast mound reconstruction, decreasing the absorption of the reconstructed nipple and increasing the hardness. The dermis(scar tissue) is taken from scar revision and/or dog-ear correction in the second stage operation after free TRAM flap breast reconstruction. And the dermis(scar tissue) graft is inserted vertically between the local flaps and horizontally under the reconstructed nipple base. Between September 2002 and February 2005, nine patients underwent C-V flap with dermis(scar tissue) graft as a part of their nipple reconstruction. The patient's ages ranged from 28 to 55 years old (mean, 41.1 years old). The follow-up period ranged from 5 to 35 months, with an average of 14.5 months. None of the nipples showed skin flap necrosis or local infection, and uneventful wound healing. Our result showed good nipple projection with less absorption and enough firmness. Our experiences shows that dermis(scar tissue) grafts in C-V flap is a very useful method for nipple reconstruction.

• Archives of Plastic Surgery
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• v.39 no.4
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• pp.384-389
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• 2012

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.

• Journal of Physiology & Pathology in Korean Medicine
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• v.20 no.5
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• pp.1223-1225
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• 2006

The purpose of this study was to examine the effects of enlarging the breast by the B-secret I , II( vaccum vibrator) in women. This study was one group in a pre-test / post-test desgian with repeated measures. The experimental group of 30 patients were selected through sampling from L-oriental medicine in the P-city. The subjects received B-secret 1 , 11 ( vaccum vibrator) for 15 - 20minutes / 1 day during three months . All of the subjects were examined on the volume-size of the breast & the degree on the improvement. Prior and post surveys were measured before and after the experiment. The volume and size of the breast were measured the girth of the chest on the breast and below breast, the range on nipple and the middle point of the clavicle, the range on nipple and the middle point of the sternum, the range out of two nipple, the lineal and obligue line distance on nipple and the under crumples of breast, the height on the nipple and the under crumples of the breast, the diameter of the girth of nipple. As the effect on enlargement and the degree on the improvement of breast by B-secret 1 , 11 ( vaccum vibrator) were observed the girth of the chest on the breast, the range on nipple and the middle point of the clavicle, the range on nipple and the sternum, the height on the nipple and the under crumples of the breast.

• Archives of Plastic Surgery
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• v.48 no.2
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• pp.179-184
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• 2021

Women attach great importance to the presence of a three-dimensional nipple upon completion of the breast reconstruction process. To meet patients' expectations, nipple-areolar complex reconstruction should achieve symmetry in position, size, shape, texture, and color, as well as minimizing donor-site morbidity. However, it is well known that regardless of the reconstructive technique, loss of nipple projection can be reasonably expected. We developed and evaluated a quick, simple, and innovative technique using injectable Integra Flowable Wound Matrix to increase nipple projection after reconstruction. Twenty breast cancer patients who underwent nipple reconstruction resulting in unsatisfactory projection were enrolled in our retrospective study. Nipple projection was measured at the time of surgery and after 6 and 12 months. A visual analogue scale was used to assess patients' satisfaction. Our technique yielded reliable results in terms of the long-lasting maintenance of nipple projection. This method is high-priced, but cost-effective, since one kit may suffice for three patients. Furthermore, our patients were very appreciative of this technique as a single-step, minimally invasive, painless procedure with no reported necessity of re-intervention.

• Archives of Plastic Surgery
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• v.34 no.4
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• pp.490-492
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• 2007

Purpose: Nipple reconstruction is an important step in breast reconstruction after mastectomy. There are considerable number of reconstructive methods developed over the past years. Each of these has not only its own special advantages, but also limitations. Therefore, no single method has become the overwhelming favorite. Sometimes it seems to be compromised when the nipple must be located directly over a linear scar. Methods: A 48-year-old female patient received a central lumpectomy with circumareolar resection of the nipple areolar complex 4 months ago. The newly designed nipple must be positioned directly astride a scar. We drew two equal-sized rectangular flaps sharing a common limb on a transverse scar and the result was two opposing plow form. Each flap size was about 1.3 cm wide and 2.5 cm long. First we elevated the flap from the distal part at a deep dermal plane, then deepened the level of dissection to raise the dermal-fat flaps. The donor site could be closed directly without any dog-ear deformity. Then we folded down the elevated flaps and loosely sutured skin with nonabsorbable materials. Each flap inner side was approximated side by side. Finally we made new natural nipple with 6 mm projection. We applied tattooing in the areola area with micropigmentation device after three months. Results: After ten months of follow-up periods, the nipple projection was stable and symmetric. The nipple projection was 3.1 mm, compared with 2.8 mm for the opposite nipple. Conclusion: Our experiences shows that this double opposing plow flap is a particularly useful and simple technique when there is a traverse scar crossing the center of the proposed nipple area.

• Archives of Plastic Surgery
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• v.47 no.1
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• pp.26-32
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• 2020

Background Nipple reconstruction is usually performed as a delayed procedure in patients with breast cancer who undergo skin-sparing mastectomy and breast reconstruction surgery using a deep inferior epigastric perforator (DIEP) flap. The authors designed this study to evaluate the utility of breast reconstruction based on a DIEP flap and immediate nipple reconstruction. Methods A retrospective review was conducted of all patients who underwent breast reconstruction performed by a single plastic surgeon from October 2016 to June 2018. Through a questionnaire and chart review, we compared surgical results and complications in cases of single-stage nipple reconstruction after skin-sparing mastectomy (n=17) with patients who underwent delayed nipple reconstruction after skin-sparing mastectomy, modified radical mastectomy, or simple mastectomy (n=7). Results In a subjective analysis using clinical photos, the immediate nipple reconstruction group had higher scores than their counterparts in an evaluation of the nipple-areolar complex (NAC) (NAC placement, 3.34 vs. 3.04; nipple projection, 3.05 vs. 3.03; nipple size, 3.30 vs. 3.29). No significant differences between the groups were found in terms of complications. Conclusions Simultaneous nipple reconstruction is a reliable surgical method with economic advantages. No differences were found in terms of outcomes and complications in comparison to delayed reconstruction. Therefore, surgeons can consider simultaneous nipple reconstruction without particular concerns about asymmetry or necrosis.

• Archives of Plastic Surgery
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• v.33 no.6
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• pp.789-791
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• 2006

Purpose: The inverted nipple presents many problems in both cosmetic and functional aspects. The histopathologic features of inverted nipple are that inverted nipple has less fibromuscular tissue than normal nipple, short lactiferous duct and dense fibrous tissue. Many papers have been reported for correction of the inverted nipple, however not many medical literatures has specifically described about traction method. Although traditional traction methods were using half of urine cup or lid of bottle, they were uncomfortable and incapable for wearing brassiere. Methods: We invented a simple and more natural method using a dome-shape plastic disposable lid of take-out cup. We applied new device for three patients after corrective surgery. Results: For long term follow up, all patients satisfied their postoperative status and they were comportable with the lids. Conclusion: This new method is very simple, comfortable, and effective method for traction. It also allows patients to wear the brassiere.