by Lee, Hun Joo; Ock,
Jae Jin
Background: Nipple reconstruction is an essential, final stage in breast
reconstruction. However, postoperative reduction in nipple projection often
results in low patient satisfaction. The authors studied the causes of the projection
decline and developed a new method using acellular dermal matrix. This research
studies the effectiveness of the new method.
Methods: The nipple flap was elevated using a modified C-V flap, and acellular
dermal matrix disk was fixed onto the floor. A column was made, into which
acellular dermal matrix fragments were put in to retain the projection. The
footprint diameter and projection at 1 year were compared with those of the
control group, in which acellular dermal matrix was not used. The authors
studied the correlation between diameter and projection and whether
reconstruction method caused any impact.
Results: At 1-year follow-up, the nipple diameter and projection in the
acellular dermal matrix group were measured to be 102.90 percent and 64.19
percent, respectively, of the baseline. Compared with the control group, the
diameter was significantly smaller (p = 0.00) and the projection was higher (p
= 0.00). A significant correlation was identified between nipple diameters and
projections, at 1-year follow-up, across the total 90 reconstructed nipples (p
= 0.00). Different reconstruction methods did not show significant differences
in terms of nipple diameter and projection, but the projections at 1 year were
highest in the latissimus dorsi flap plus implant group, followed by the
expander group and the transverse rectus abdominis musculocutaneous flap group.
Conclusion: Nipple reconstruction using acellular dermal matrix disk and fragments
prevents downward shifting of the nipple tissue and broadening of the footprint
diameter and thus is favorable for long-term maintenance of nipple projection.
