title: Nipple Reconstruction with Dorsal Skin Provides Better Projection than Reconstruction with Abdominal or Breast Skin with Cartilage Grafting.
abstract: Nipple projection of a modified C-V flap with or without costal cartilage was compared on abdominal, breast, and dorsal skin. A total of 81 patients and 85 sites were studied. The nipple was reconstructed secondarily using a modified C-V flap. Patients were classified by breast mound skin into five groups: dorsal skin without cartilage (group A, n = 18); abdominal skin without cartilage (group B, n = 6); abdominal skin with cartilage (group C, n = 26); breast skin without cartilage (group D, n = 20); and breast skin with cartilage (group E, n = 15). Complications and nipple projection were evaluated over a mean follow-up of 18.5 months; there were no significant differences among the five groups. Minor flap necrosis occurred in 10/18, 0/6, 4/26, 1/20, and 2/15 of groups A, B, C, D, and E, respectively; the percentage was higher in group A than in group D. The average projection maintenance rate (postoperative nipple projection to V flap width) was 76.5, 50.1, 56.1, 46.1, and 52.3% for groups A, B, C, D, and E, respectively; the value in group A was higher than in all other groups. Despite more minor necrosis, the nipple reconstructed with dorsal skin maintained better projection than the nipple reconstructed with abdominal skin or breast skin combined with a cartilage graft. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the A3 online Instructions to Authors. www.springer.com/00266 .
authors.affiliation: Department of Plastic and Reconstructive Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.
authors.forename: Runa
authors.initials: R
authors.lastname: Mihara
authors.affiliation: Department of Plastic and Reconstructive Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan. moriplas@tmd.ac.jp.
authors.forename: Hiroki
authors.identifier: http://orcid.org/0000-0003-3190-6852
authors.initials: H
authors.lastname: Mori
authors.affiliation: Department of Plastic and Reconstructive Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.
authors.forename: Mutsumi
authors.initials: M
authors.lastname: Okazaki
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery; D002356:Cartilage / Q000637:transplantation*; D015331:Cohort Studies; D004954:Esthetics; D005260:Female; D006085:Graft Survival; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods*; D008408:Mastectomy / Q000379:methods; D008875:Middle Aged; D064827:Myocutaneous Flap / Q000098:blood supply / Q000637:transplantation; D009558:Nipples / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment; D016038:Skin Transplantation / Q000379:methods; D013524:Surgical Flaps / Q000098:blood supply / Q000637:transplantation*; D014945:Wound Healing / Q000502:physiology
keywords: Costal cartilage; Dorsal skin; Modified C–V flap; Nipple reconstruction