Heo Jae-Woo, Park Seong Oh, Jin Ung Sik
Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, Republic of Korea.
Department of Plastic and Reconstructive Surgery, Hanyang University Seoul Hospital, Seoul, Republic of Korea.
Aesthetic Plast Surg. 2018 Dec;42(6):1478-1484. doi: 10.1007/s00266-018-1162-6. Epub 2018 Jun 13.
Nipple-areolar complex reconstruction is the final step of the reconstructive procedure in breast cancer patients. Nowadays, a combination of a local flap for nipple reconstruction and skin grafting or tattooing for areola reconstruction is deemed a first choice. In this paper, we are combining the techniques of local flap and full-thickness skin graft from the upper inner thigh for simultaneous reconstruction of the nipple and areola.
From January, 2016 to December, 2017, 23 female patients with an absent unilateral nipple-areolar complex due to post-oncological mastectomy and immediate implant-based breast reconstruction were subjects of the study. On an out-patient clinic basis, the percentage of the nipple projection loss was calculated at the intervals of 3 , 6 and 12 months postoperatively. At the final visit, the patient's subjective satisfaction on the reconstructed areola compared to the normal contralateral side was evaluated using a visual analogue scale.
Over the course of time, the mean nipple projection loss was 20.16 ± 12.88, 31.78 ± 11.63 and 34.69 ± 12.01% at 3 , 6 and 12 months postoperatively, respectively. Patients' overall satisfaction on the grafted areola was as follows; the largest number of patients (8 patients) had a 'good' satisfaction 12-months postoperatively. Out of 21 patients, those who considered the result to be 'poor' and 'disappointing' each accounted for 1 and 3 patients.
The combination of nipple-areolar complex reconstruction technique introduced in this study has proven to be a safe and efficacious alternative in patients with implant-based reconstruction requiring small- to medium-sized nipple projection, especially when the skin envelope is too tight for a local flap only.
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 online Instructions to Authors www.springer.com/00266 .
乳头乳晕复合体重建是乳腺癌患者重建手术的最后一步。如今，采用局部皮瓣进行乳头重建并结合植皮或纹身进行乳晕重建被视为首选方法。在本文中，我们将局部皮瓣技术与取自大腿内侧上部的全厚皮片相结合，用于同时重建乳头和乳晕。
2016年1月至2017年12月，23例因肿瘤切除术后即刻植入式乳房重建导致单侧乳头乳晕复合体缺失的女性患者纳入本研究。在门诊基础上，分别于术后3、6和12个月计算乳头突出度丢失的百分比。在最后一次随访时，使用视觉模拟量表评估患者对重建乳晕与对侧正常乳晕相比的主观满意度。
随着时间推移，术后3、6和12个月时乳头突出度平均丢失分别为20.16±12.88%、31.78±11.63%和34.69±12.01%。患者对移植乳晕的总体满意度如下：术后12个月时，最多患者（8例）表示“满意”。在21例患者中，认为结果“差”和“令人失望”的分别为1例和3例。
本研究中引入的乳头乳晕复合体重建技术组合已被证明是一种安全有效的替代方法，适用于需要中小乳头突出度的植入式重建患者，特别是当皮肤包膜过紧而无法仅使用局部皮瓣时。
证据水平IV：本刊要求作者为每篇文章指定证据水平。有关这些循证医学评级的完整描述，请参阅目录或作者在线指南www.springer.com/00266 。
