title: Nipple Reconstruction After Autologous or Expander Breast Reconstruction: A Multimodal and 3-Dimensional Analysis.
abstract: BACKGROUND
  Little is known about the influence of the underlying tissue as donor for nipple-areola complex (NAC) reconstruction. Also, there is a complete lack of knowledge about the fate of nipple volume.
  
  
  OBJECTIVE
  The goal of this retrospective, single-institution study was to analyze a case series after nipple reconstruction using a multimodal evaluation including 3-dimensional (3D) laser scanner analyses.
  
  
  METHODS
  Unilateral mastectomy patients after either expander-based or autologous breast reconstruction using the skate flap were included. NAC caliper measurement of nipple and areola size was performed. 3D laser scanner analysis (Minolta Vivid 900) was used to calculate nipple volume, measurement of nipple, and areolar projection and diameter. Sensitivity was evaluated using the Semmes Weinstein test and patient satisfaction by a visual analog scale (VAS 1-10).
  
  
  RESULTS
  A total of 10 patients were included in the expander group and 12 patients were included in the flap group. After a median follow-up period of 32 months in the expander group and 34 months in the flap group, non-contact 3D laser surface scanning revealed a difference in projection of 55 to 60% compared to the contralateral side. The contraction in all 3 dimensions led to a dramatic difference in nipple volume with 12 ± 8% (flap reconstructions) and 12 ± 7% (expander reconstructions). Sensitivity of the areola showed better values after expander-based reconstruction. Despite the significant discrepancy in nipple volume and projection as well as areolar diameter, overall patient satisfaction was acceptable (VAS 4.1 ± 3.5).
  
  
  CONCLUSIONS
  Volume assessment revealed a massive asymmetry to the intact nipple but not between expander and flap reconstructions. Although asymmetry of the areola and nipple remains, patient satisfaction is acceptable. LEVEL OF EVIDENCE 4.
authors.affiliation: Dr Tremp is a Plastic Surgeon and Attending, Dr Oranges is a Plastic Surgeon and PhD candidate, Dr Wettstein is a Plastic Surgeon and Consultant, and Prof Kalbermatten is a Plastic Surgeon and Medical Director at the Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland. Dr di Summa is a Plastic Surgeon and Attending, and Dr Schaakxs is a Resident, Division of Plastic, Reconstructive, and Aesthetic Surgery, CHUV, University Hospital of Lausanne, Lausanne, Switzerland.
authors.forename: Mathias
authors.initials: M
authors.lastname: Tremp
authors.affiliation: Dr Tremp is a Plastic Surgeon and Attending, Dr Oranges is a Plastic Surgeon and PhD candidate, Dr Wettstein is a Plastic Surgeon and Consultant, and Prof Kalbermatten is a Plastic Surgeon and Medical Director at the Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland. Dr di Summa is a Plastic Surgeon and Attending, and Dr Schaakxs is a Resident, Division of Plastic, Reconstructive, and Aesthetic Surgery, CHUV, University Hospital of Lausanne, Lausanne, Switzerland.
authors.forename: Pietro G
authors.initials: PG
authors.lastname: di Summa
authors.affiliation: Dr Tremp is a Plastic Surgeon and Attending, Dr Oranges is a Plastic Surgeon and PhD candidate, Dr Wettstein is a Plastic Surgeon and Consultant, and Prof Kalbermatten is a Plastic Surgeon and Medical Director at the Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland. Dr di Summa is a Plastic Surgeon and Attending, and Dr Schaakxs is a Resident, Division of Plastic, Reconstructive, and Aesthetic Surgery, CHUV, University Hospital of Lausanne, Lausanne, Switzerland.
authors.forename: Dominique
authors.initials: D
authors.lastname: Schaakxs
authors.affiliation: Dr Tremp is a Plastic Surgeon and Attending, Dr Oranges is a Plastic Surgeon and PhD candidate, Dr Wettstein is a Plastic Surgeon and Consultant, and Prof Kalbermatten is a Plastic Surgeon and Medical Director at the Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland. Dr di Summa is a Plastic Surgeon and Attending, and Dr Schaakxs is a Resident, Division of Plastic, Reconstructive, and Aesthetic Surgery, CHUV, University Hospital of Lausanne, Lausanne, Switzerland.
authors.forename: Carlo M
authors.initials: CM
authors.lastname: Oranges
authors.affiliation: Dr Tremp is a Plastic Surgeon and Attending, Dr Oranges is a Plastic Surgeon and PhD candidate, Dr Wettstein is a Plastic Surgeon and Consultant, and Prof Kalbermatten is a Plastic Surgeon and Medical Director at the Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland. Dr di Summa is a Plastic Surgeon and Attending, and Dr Schaakxs is a Resident, Division of Plastic, Reconstructive, and Aesthetic Surgery, CHUV, University Hospital of Lausanne, Lausanne, Switzerland.
authors.forename: Reto
authors.initials: R
authors.lastname: Wettstein
authors.affiliation: Dr Tremp is a Plastic Surgeon and Attending, Dr Oranges is a Plastic Surgeon and PhD candidate, Dr Wettstein is a Plastic Surgeon and Consultant, and Prof Kalbermatten is a Plastic Surgeon and Medical Director at the Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland. Dr di Summa is a Plastic Surgeon and Attending, and Dr Schaakxs is a Resident, Division of Plastic, Reconstructive, and Aesthetic Surgery, CHUV, University Hospital of Lausanne, Lausanne, Switzerland. daniel.kalbermatten@usb.ch.
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Kalbermatten
mesh_terms: D000328:Adult; D059925:Anatomic Landmarks; D004954:Esthetics; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D021621:Imaging, Three-Dimensional / Q000379:methods*; D016462:Mammaplasty / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D008408:Mastectomy; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D009558:Nipples / Q000033:anatomy & histology / Q000601:surgery*; D017060:Patient Satisfaction; D010781:Photography; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013524:Surgical Flaps; D011795:Surveys and Questionnaires; D013557:Switzerland; D013997:Time Factors; D015626:Tissue Expansion / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D015625:Tissue Expansion Devices; D014182:Transplantation, Autologous; D016896:Treatment Outcome