title: Nipple reconstruction after implant-based breast reconstruction in radiated patients: A new safe dermal flap.
abstract: BACKGROUND
  After implant-based breast reconstruction, the nipple reconstruction technique must be carefully chosen, especially in patients with a history of radiotherapy. When the contralateral nipple is not available, using a classical dermal-fat local flap may lead to the implant exposure, and consequently, removal. We describe here a simple nipple reconstruction technique, using a strictly dermal local flap and evaluate its complication rate.
  
  
  METHODS
  All patients who underwent our technique for nipple reconstruction between January 2012 and April 2015 were included in this retrospective study. We described our surgical technique and noted the occurrence of postoperative complications.
  
  
  RESULTS
  Forty-nine nipples, in 47 patients with a history of radiotherapy, were reconstructed with our technique. The mean age was 53 years old (range 27-78 years old). The average time between radiotherapy and nipple reconstruction was 42.5 months (range from 4.6 to 274.8 months). The mean follow-up was 30.9 months (range from 6 to 47 months). No implant exposure occurred. Regarding the nipple flap, two partial flap loss and one infection occurred, the whole complication rate was 6.1%. Regarding nipple projection, it was quite low (between 2 and 5 mm) after 6 months, but remained stable.
  
  
  CONCLUSIONS
  Our strictly dermal local flap technique for nipple reconstruction is a safe procedure and represents a good alternative to composite contralateral nipple graft in irradiated patients with an implant-based reconstructed breast.
authors.affiliation: Plastic, Reconstructive and Aesthetic Surgery Department, AP-HP, Hôpital Saint-Louis, F-75010 Paris, France. Electronic address: dr.kessara.rem@gmail.com.
authors.forename: K
authors.initials: K
authors.lastname: Rem
authors.affiliation: Plastic, Reconstructive and Aesthetic Surgery Department, AP-HP, Hôpital Saint-Louis, F-75010 Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Al Hindi
authors.affiliation: Plastic, Reconstructive and Aesthetic Surgery Department, AP-HP, Hôpital Saint-Louis, F-75010 Paris, France.
authors.forename: T
authors.initials: T
authors.lastname: Sorin
authors.affiliation: Paris Diderot University, Sorbonne Paris Cité, 75010 Paris, France; Plastic, Reconstructive and Aesthetic Surgery Department, AP-HP, Hôpital Saint-Louis, F-75010 Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Ozil
authors.affiliation: Paris Diderot University, Sorbonne Paris Cité, 75010 Paris, France; Plastic, Reconstructive and Aesthetic Surgery Department, AP-HP, Hôpital Saint-Louis, F-75010 Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Revol
authors.affiliation: Paris Diderot University, Sorbonne Paris Cité, 75010 Paris, France; Plastic, Reconstructive and Aesthetic Surgery Department, AP-HP, Hôpital Saint-Louis, F-75010 Paris, France.
authors.forename: S
authors.initials: S
authors.lastname: Mazouz Dorval
mesh_terms: D000328:Adult; D000368:Aged; D018427:Breast Implants; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D009558:Nipples / Q000528:radiation effects / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000009:adverse effects; D013997:Time Factors
keywords: Breast cancer; Breast reconstruction; Implant-based breast reconstruction; Nipple reconstruction; Radiotherapy