Augmentation of the Nipples Reconstructed with Modified Top-Hat Flap Using Dermal Grafts in Implant-Based Breast Reconstruction: A Comparative Study

• Published in: Aesthetic plastic surgery Vol. 41; no. 4; pp. 800 - 805
• Main Authors: Kim, Hoon, Kim, Sang Il, Ha, Won, Yoon, Chi Sun, Lee, Taik Jong, Kim, Kyu Nam
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.08.2017; Springer Nature B.V
• Subjects: Adult; Autografts; Breast Implantation; Breast Neoplasms - pathology; Breast Neoplasms - surgery; Cohort Studies; Esthetics; Female; Follow-Up Studies; Graft Survival; Humans; Mammaplasty - methods; Mastectomy; Mastectomy - methods; Medicine; Medicine & Public Health; Middle Aged; Myocutaneous Flap - blood supply; Myocutaneous Flap - transplantation; Nipples - surgery; Original Article; Otorhinolaryngology; Plastic Surgery; Republic of Korea; Retrospective Studies; Risk Assessment; Skin Transplantation - methods; Treatment Outcome; Wound Healing - physiology; Breast implant; Nipple reconstruction; Breast reconstruction; Dermis graft
• ISSN: 0364-216X; 1432-5241
• DOI: 10.1007/s00266-017-0806-2

Background Nipple reconstruction in implant-based breast reconstruction remains challenging, as the remaining thin skin envelope results in a less projected neo-nipple with a reduced volume. This study presents a modified top-hat flap technique with rolled dermal grafts from the dog-ears of lateral wings for augmenting reconstructed nipples during implant-based breast reconstruction. Methods Between April 2011 and December 2014, among 34 patients who underwent immediate post-mastectomy reconstruction with a direct silicone implant, nipple reconstruction was performed using the modified top-hat flap technique in only 21 patients (group A), whereas 13 patients underwent the modified top-hat flap technique with rolled dermal grafts from the dog-ears of lateral wings (group B). The projection and width of the neo-nipple were measured at the time of surgery and at 1 year post-surgery, respectively. Results All modified top-hat flaps were successful without any complications. The mean nipple projections at the time of surgery were 0.75 ± 0.107 cm (range 0.5–0.9 cm) and 1.29 ± 0.064 cm (range 1.2–1.4 cm) in groups A and B, respectively ( p  < 0.001). The mean nipple widths at the time of surgery were 0.90 ± 0.184 cm (range 0.6–1.2 cm) and 1.43 ± 0.076 cm (range 1.3–1.5 cm) in groups A and B, respectively ( p  < 0.001). The maintenance of nipple projection and width was significantly increased in group B compared with group A. Conclusion The modified top-hat flap technique with rolled dermal grafts from the dog-ears of lateral wings is a useful and easy method to expand and augment the volume of reconstructed nipples in implant-based breast reconstruction. Level of Evidence III This journal requires that authors assign a level of evidence to each article. 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 .