Plastic
& Reconstructive Surgery:
January 2016 -
Volume 137 - Issue 1 - p 14e–23e
Winocour, S et al.
Background: Many
techniques have been described for nipple reconstruction, with the principal
limitation being excessive loss of projection. The ideal reconstructed nipple
provides sustained projection, the fewest complications, and high levels of
patient satisfaction. A variety of materials are available for projection
augmentation, including autologous, allogeneic, and synthetic materials. To
date, there has been no systematic review to study the efficacy, projection,
and complication rates of different materials used in nipple reconstruction.
Methods: MEDLINE, Embase, and PubMed databases were searched, from inception to
August of 2014, to identify literature reporting on outcomes of autologous,
allogeneic, and synthetic grafts in nipple reconstruction. Retrospective and
prospective studies with controlled and uncontrolled conditions were included.
Studies reporting the use of autologous flap techniques without grafts and
articles lacking postoperative outcomes were excluded. Study quality was
assessed using the Newcastle-Ottawa Scale. Results: Thirty-one studies met the
inclusion criteria. After evidence review, one study represented two of nine
stars on the Newcastle-Ottawa Scale, two studies represented three stars, six
studies represented four stars, seven studies represented five stars, 11 studies
represented six stars, and four studies represented seven stars. Conclusions:
The results of this review revealed heterogeneity in the type of material used
within each category and inconsistent methodology used in outcomes assessment
in nipple reconstruction. Overall, the quality of evidence is low. Synthetic
materials have higher complication rates and allogeneic grafts have nipple
projection comparable to that of autologous grafts. Further investigation with
high-level evidence is necessary to determine the optimal material for nipple
reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
