Reconstruction of the Nipple-Areolar Complex Flashcards
Nonsurgical options are also available and can achieve satisfactory reconstitution of the NAC.
T
segment of the
the contralateral natural nipple is harvested and transferred to the reconstructed breast as a composite graft called nipple share technique
T
This technique is most effective
in patients with a large contralateral nipple where projection exceeds
10 mm
F This technique is most effective
in patients with a large contralateral nipple where projection exceeds
5 to 6 mm
composite nipple grafting cannot
provide sensation and erectile function in the reconstructed nipple
F composite nipple grafting can
provide sensation and erectile function in the reconstructed nipple
in some cases.
The risk of reduced sensation and impaired
erectile function at the donor site has limited the popularity of nipple sharing
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In an effort to avoid contralateral surgery, banking of
the affected nipple at the time of mastectomy has been proposed
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Drawback of cryopreservation of the nipple
cryopreservation of the nipple results in tissue damage and
loss of pigmentation that adversely affects aesthetic outcomes.
Grafting remains a favorable option in patients who have thin skin
and subcutaneous tissues following alloplastic breast reconstruction.
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donor sites for nipple grafts including
labia, earlobe, toe pulp, and skin from the postauricular area, medial
thigh, and axilla
T
The popularity of grafting has waned with
the advent of a multitude of local flap techniques that eliminate the
need for a secondary donor site and the risk of associated morbidity
T
classification
system of nipple reconstruction of local flap
(1) centrally based flaps,
(2) subdermal pedicle local flaps with single pedicle,
(3) subdermal pedicle local flaps with double pedicle.
The commonest techniques currently in use (skate flap, star flap, and C-V flap)
consist of two larger lateral flaps that are approximated to create the
circumference of the nipple and a smaller central flap that forms the
tip of the nipple
T
long-term loss ofnipple projection reported to be between
10% and 50%
F long-term loss ofnipple projection reported to be between
40% and 70%
reconstructed nipple loses
projection in the first year
F Studies suggest that the reconstructed nipple loses
projection in the first 2 years postoperatively, after which time the
height remains relatively stable
double wide-based flaps that preserve rich subdermal vascularity may limit postoperative contracture.
T
Incorporation of subcutaneous fat or de-epithelialized dermis into the lateral flaps may
increase the bulk of the reconstructed nipple
T
Centrally based
flaps such as the quadrapod flap are subject to the highest degree of
postoperative retraction.
T
surgeons should aim to create a nipple that is at
least 50% larger than required
T
Augmentation techniques have been described in an effort to
improve nipple projection
T
auricular cartilage is better utilized than costal cartilage in breast reconstruction with nipple
F costal cartilage was identified as a more accessible autologous material because it could be harvested and banked at
the time of the initial breast reconstruction and eliminated the need
for additional donor sites
Using fat rather than cartilage is safer for nipple reconstruction
T
The soft consistency of fat grafts may reduce the risk of flap
necrosis,
T
Acellular dermal matrix and prefabricated collagen tubes can also be used to support local flap reconstruction
T
Several
alloplastic augmentation techniques have also been described including calcium hydroxylapatite, silicone, hyaluronic acid, and polytetrafluoroethylene.
T
The contralateral areola is the ideal source of
donor skin and commonly used
F but is rarely used unless the patient is undergoing a concomitant balancing breast reduction
Grafting of the areola usually occurs at the same time
as nipple reconstruction. An area ofdeepithelialization can be incorporated into the nipple flap design to accommodate the skin graft
t
Fading
ofpigmented skin grafts commonly occurs over time
T
Intradermal tattooing has become a popular method of areola reconstruction.
T
Tattoo pigments, consisting of iron and titanium
oxides, are deposited into the dermis using a dermabrasion technique.
T
The initial tattoo should
be darker than required in anticipation of this
T
Deposition of pigment at the correct dermal level is also important why?
because if it is too superficial, it will slough off in the early postoperative period, but if it is too deep, it will be degraded by macrophage activity
Tattooing is
generally performed 4 weeks after reconstruction of the nipple
F Tattooing is
generally performed 6 to 8 weeks after reconstruction of the nipple
some surgeons advocate
tattooing of the areola prior to nipple reconstruction
T
The tattoo simulates the nipple projection through color contrasts and also mimics the texture of a natural
areola.
T
The commonest complications are loss of projection and fading of
pigmentation over time.
T
