title: A Systematic Review of Comparison of Autologous, Allogeneic, and Synthetic Augmentation Grafts in Nipple Reconstruction.
abstract: 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.
  
  
  METHODS
  Therapeutic, IV.
authors.affiliation: Rochester, Minn. From the Division of Plastic Surgery, Department of Surgery, Mayo Clinic.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Winocour
authors.forename: Anshuman
authors.initials: A
authors.lastname: Saksena
authors.forename: Christine
authors.initials: C
authors.lastname: Oh
authors.forename: Peter S
authors.initials: PS
authors.lastname: Wu
authors.forename: Alexis
authors.initials: A
authors.lastname: Laungani
authors.forename: Heather
authors.initials: H
authors.lastname: Baltzer
authors.forename: Michel
authors.initials: M
authors.lastname: Saint-Cyr
mesh_terms: D004954:Esthetics; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D009558:Nipples / Q000601:surgery*; D018570:Risk Assessment; D017768:Skin, Artificial; D013524:Surgical Flaps / Q000098:blood supply*; D015626:Tissue Expansion / Q000379:methods; D014182:Transplantation, Autologous / Q000379:methods; D014184:Transplantation, Homologous / Q000379:methods; D016896:Treatment Outcome