Silicone rod enables permanent nipple projection after breast reconstruction
MedWire News: Nipple reconstruction using the C-V flap technique combined with insertion of a silicone rod results in permanent nipple projection after autologous breast reconstruction following radical mastectomy, Polish researchers report.
The nipple-areola complex (NAC) is a unique part of the human body, not only is it a functional structure, but it plays an aesthetic role as well, remark Jerzy Jankau and colleagues from the Medical University of Gdansk.
They explain that NAC recreation is the last stage of breast reconstruction following mastectomy and is usually performed within 3-4 months of the breast mound reconstruction.
However, post-surgical loss of nipple projection is a common problem among these patients, the researchers add.
To investigate possible solutions, Jankau and colleagues evaluated a novel method that combines Loksen's C-V flap technique with the insertion of a silicone rod that supports the nipple.
The procedure was performed in 10 women who underwent breast reconstruction with a latissimus dorsi flap (LDf) and Becker or expander prosthesis, and in 20 women who underwent autologous tissue reconstruction with a transverse rectus abdominis fusculocutaneous (TRAM) flap.
As reported in the journal The Breast, all the patients who underwent the LDf procedure developed flap necrosis with silicone rod exposure within 7-21 days of the reconstruction and subsequently required rod removal.
The researchers speculate that the procedure failed in these women because the Becker or expander prosthesis exerted excessive pressure on the surrounding tissues in the central point of the reconstructed nipple.
In contrast, no necrosis or wound split was observed in the women who underwent TRAM flap reconstruction, and healing progressed without complications.
Furthermore, durable nipple projection was achieved in this group. Specifically, at 6 months post-TRAM, the diameter and height of the nipple had shrunk by an average 24.5% and 23.1% respectively. The respective values at 10 months were 34.5% and 32.4%.
It was not possible to take similar measurements in the LDf group as the nipple shrunk to a "button" form upon removal of the silicone rod.
Jankau and co-authors conclude that their technique makes it possible to recreate an NAC that resembles the contralateral breast in terms of position, size, and projection.
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By Laura Dean