Research progress in nipple projection reconstruction based on tissue graft support_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Xiaoshan ,  DENG Chengliang

Department of Burns and Plastic Surgery, Collaborative Innovation Center for Tissue Damage Repair and Regenerative Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China;

Corresponding author：

DENG Chengliang, Email: cheliadeng@sina.com

Keywords：

Nipple reconstruction; tissue transplantation; nipple projection

DOI：

10.7507/1002-1892.202304096

Video：

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Objective To review the advances in methods for reconstructing nipple projection based on tissue graft support. Methods The literature related to nipple projection reconstruction based on tissue graft support was reviewed and summarized in terms of the advantages and disadvantages of various tissue grafts and the improved nipple projection results. Results Loss of nipple projection is a common cause of decreased patient’s satisfaction. Reconstructing nipple projection based on tissue graft support is a more common clinical method and can be done with autologous and allogeneic tissues. Autologous tissue grafts include dermis, adipose tissue with dermis, adipose tissue, ear cartilage, rib cartilage, and contralateral nipple tissue. Autologous tissue grafts are easy to obtain and have no immune rejection, but may lead to donor area damage and prolong the surgical time for tissue collection. Allogeneic tissue grafts include acellular dermal matrix, lyophilized rib cartilage, and extracellular matrix collagen, and decellularized nipple tissue. Allogeneic tissue grafts do not cause additional donor area damage, are highly malleable, and can be designed to be utilized according to the recipient area, but the high cost often limits the development of this technique. Conclusion There is no gold standard regarding tissue graft-assisted nipple projection reconstruction techniques, and there are advantages and disadvantages to both autologous and allogeneic tissue grafts. Surgeons should choose the appropriate graft based on the actual condition of the patient.

Citation： ZHANG Xiaoshan, DENG Chengliang. Research progress in nipple projection reconstruction based on tissue graft support. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(8): 1031-1036. doi: 10.7507/1002-1892.202304096 Copy

1.	Sisti A, Pica Alfieri E, Brandi C, et al. Nipple-areola complex reconstruction. Plast Reconstr Surg, 2018, 142(5): 793e. doi: 10.3390/medicina56060296.
2.	Sisti A, Tassinari J, Nisi G, et al. Autologous, allogeneic, and synthetic augmentation grafts in nipple reconstruction. Plast Reconstr Surg, 2016, 138(5): 936e-937e.
3.	Gruber RP. Nipple-areola reconstruction: a review of techniques. Clin Plast Surg, 1979, 6(1): 71-83.
4.	Egan KG, Cullom M, Nazir N, et al. Patient satisfaction increases with nipple reconstruction following autologous breast reconstruction. Plast Reconstr Surg, 2021, 148(2): 177e-184e.
5.	Gougoutas AJ, Said HK, Um G, et al. Nipple-areola complex reconstruction. Plast Reconstr Surg, 2018, 141(3): 404e-416e.
6.	Eo S, Kim SS, Da Lio AL. Nipple reconstruction with C-V flap using dermofat graft. Ann Plast Surg, 2007, 58(2): 137-140.
7.	Elizabeth Clark S, Turton E. The CC-V flap: a novel technique for augmenting a C-V nipple reconstruction using a free dermal graft. World J Plast Surg, 2014, 3(1): 8-12.
8.	Chia HL, Wong M, Tan BK. Nipple reconstruction with rolled dermal graft support. Arch Plast Surg, 2014, 41(2): 158-162.
9.	Kurlander DE, Collis G, Bernard S. Autologous dermal fat graft modification for skate flap nipple reconstruction. J Plast Reconstr Aesthet Surg, 2016, 69(2): e44-e45.
10.	宋延刚, 李发成, 黄桂林. 星状皮瓣结合乳房真皮脂肪瓣乳头再造及乳房下皱襞重建的临床观察. 首都医科大学学报, 2019, 40(4): 656-660.
11.	Temiz G, Yeşiloğlu N, Şirinoğlu H, et al. A New modification of C-V flap technique in nipple reconstruction: rolled triangular dermal-fat flaps. Aesthetic Plast Surg, 2015, 39(1): 173-175.
12.	Bernard RW, Beran SJ. Autologous fat graft in nipple reconstruction. Plast Reconstr Surg, 2003, 112(4): 964-968.
13.	Brent B, Bostwick J. Nipple-areola reconstruction with auricular tissues. Plast Reconstr Surg, 1977, 60(3): 353-361.
14.	Tanabe HY, Tai Y, Kiyokawa K, et al. Nipple-areola reconstruction with a dermal-fat flap and rolled auricular cartilage. Plast Reconstr Surg, 1997, 100(2): 431-438.
15.	Norton S, Akhavani MA, Kang N. The ‘Hamburger’ technique for harvesting cartilage grafts in nipple reconstruction. J Plast Reconstr Aesthet Surg, 2007, 60(8): 957-959.
16.	Jones AP, Erdmann M. Projection and patient satisfaction using the “Hamburger” nipple reconstruction technique. J Plast Reconstr Aesthet Surg, 2012, 65(2): 207-212.
17.	崔军威, 刘晓岭, 杨子健, 等. 自体肋软骨支架乳头再造在乳房假体重建手术中的应用体会. 中华乳腺病杂志 (电子版), 2021, 15(4): 201-205.
18.	Heitland A, Markowicz M, Koellensperger E, et al. Long-term nipple shrinkage following augmentation by an autologous rib cartilage transplant in free DIEP-flaps. J Plast Reconstr Aesthet Surg, 2006, 59(10): 1063-1067.
19.	Lipa JE, Addison PD, Neligan PC. Patient satisfaction following nipple reconstruction incorporating autologous costal cartilage. Can J Plast Surg, 2008, 16(2): 85-88.
20.	Guerid S, Boucher F, Mojallal A. Nipple reconstruction using rib cartilage strut in microsurgical reconstructed breast. Ann Chir Plast Esthet, 2017, 62(4): 332-335.
21.	Tokumoto H, Akita S, Kosaka K, et al. Utilization of a partial rib-sparing procedure in microvascular breast reconstruction for preserving intercostal nerve and nipple reconstruction. J Plast Reconstr Aesthet Surg, 2022, 75(12): 4354-4360.
22.	Guerra AB, Khoobehi K, Metzinger SE, et al. New technique for nipple areola reconstruction: arrow flap and rib cartilage graft for long-lasting nipple projection. Ann Plast Surg, 2003, 50(1): 31-37.
23.	Cheng MH, Rodriguez ED, Smartt JM, et al. Nipple reconstruction using the modified top hat flap with banked costal cartilage graft: long-term follow-up in 58 patients. Ann Plast Surg, 2007, 59(6): 621-628.
24.	Wolf O, Liu J, Legarda C, et al. The spare-parts technique: A safe and efficient single-stage nipple and areola reconstruction. J Plast Reconstr Aesthet Surg, 2020, 73(10): 1871-1878.
25.	Dong X, Premaratne ID, Sariibrahimoglu K, et al. 3D-printed poly-4-hydroxybutyrate bioabsorbable scaffolds for nipple reconstruction. Acta Biomater, 2022, 143: 333-343.
26.	Bhatty MA, Berry RB. Nipple-areola reconstruction by tattooing and nipple sharing. Br J Plast Surg, 1997, 50(5): 331-334.
27.	Lee TJ, Noh HJ, Kim EK, et al. Reducing donor site morbidity when reconstructing the nipple using a composite nipple graft. Arch Plast Surg, 2012, 39(4): 384-389.
28.	Sakai S, Taneda H. New nipple-sharing technique that preserves the anatomic structure of the donor nipple for breastfeeding. Aesthetic Plast Surg, 2012, 36(2): 308-312.
29.	Wong AW, Chew KY, Tan BK. Two-blade guillotine technique for nipple graft harvest. Arch Plast Surg, 2017, 44(5): 449-452.
30.	Tanaka Y. Tissue engineering treatment for the nipple-sharing donor site. Aesthetic Plast Surg, 2021, 45(6): 3083-3087.
31.	Wraight WM, Davison JA. Nipple sharing for nipple-areolar complex reconstruction: still a useful technique. J Plast Reconstr Aesthet Surg, 2006, 59(12): 1471-1472.
32.	Sisti A. Nipple-areola complex reconstruction. Medicina (Kaunas), 2020, 56(6): 296.
33.	Holton LH, Haerian H, Silverman RP, et al. Improving long-term projection in nipple reconstruction using human acellular dermal matrix: an animal model. Ann Plast Surg, 2005, 55(3): 304-309.
34.	Nahabedian MY. Secondary nipple reconstruction using local flaps and AlloDerm. Plast Reconstr Surg, 2005, 115(7): 2056-2061.
35.	Garramone CE, Lam B. Use of AlloDerm in primary nipple reconstruction to improve long-term nipple projection. Plast Reconstr Surg, 2007, 119(6): 1663-1668.
36.	Chen WF, Barounis D, Kalimuthu R. A novel cost-saving approach to the use of acellular dermal matrix (AlloDerm) in postmastectomy breast and nipple reconstructions. Plast Reconstr Surg, 2010, 125(2): 479-481.
37.	Park GY, Yoon ES, Cho HE, et al. Acellular dermal matrix as a core strut for projection in nipple reconstruction: approaches for three different methods of breast reconstruction. Arch Plast Surg, 2016, 43(5): 424-429.
38.	Hwang E, Yang JY, Ha HJ, et al. Nipple reconstruction using the semilunar flap and omega-shaped acellular dermal matrix strut. Aesthetic Plast Surg, 2022, 46(1): 152-160.
39.	Kim EK, Lee TJ. Use of lyophilized allogeneic costal cartilage: is it effective to maintain the projection of the reconstructed nipple? Ann Plast Surg, 2011, 66(2): 128-130.
40.	Demir Z, Velidedeoğlu H, Sahin U, et al. Preserved costal cartilage homograft application for the treatment of temporomandibular joint ankylosis. Plast Reconstr Surg, 2001, 108(1): 44-51.
41.	Velidedeoğlu H, Demir Z, Sahin U, et al. Block and surgicel-wrapped diced solvent-preserved costal cartilage homograft application for nasal augmentation. Plast Reconstr Surg, 2005, 115(7): 2081-2093.
42.	Strauch B, Wallach SG. Reconstruction with irradiated homograft costal cartilage. Plast Reconstr Surg, 2003, 111(7): 2405-2411.
43.	Chang JS, Becker SS, Park SS. Nasal reconstruction: the state of the art. Curr Opin Otolaryngol Head Neck Surg, 2004, 12(4): 336-343.
44.	Tierney BP, Hodde JP, Changkuon DI. Biologic collagen cylinder with skate flap technique for nipple reconstruction. Plast Surg Int, 2014, 2014: 194087. doi: 10.1155/2014/194087.
45.	Collins B, Williams JZ, Karu H, et al. Nipple reconstruction with the biodesign nipple reconstruction cylinder: a prospective clinical study. Plast Reconstr Surg Glob Open, 2016, 4(8): e832.
46.	Pashos NC, Graham DM, Burkett BJ, et al. Acellular biologic nipple-areolar complex graft: in vivo murine and nonhuman primate host response evaluation. Tissue Eng Part A, 2020, 26(15-16): 872-885.
47.	Johnson PC, Klein GL. Orthotopic grafting of decellularized human nipple: Setting the stage and putative mechanism of healing. Breast, 2020, 54: 96-98.
48.	Caronna VC, Rosenberg AF, Graham DM, et al. Viability of acellular biologic graft for nipple-areolar complex reconstruction in a non-human primate model. Sci Rep, 2021, 11(1): 15085.

1. Sisti A, Pica Alfieri E, Brandi C, et al. Nipple-areola complex reconstruction. Plast Reconstr Surg, 2018, 142(5): 793e. doi: 10.3390/medicina56060296.
2. Sisti A, Tassinari J, Nisi G, et al. Autologous, allogeneic, and synthetic augmentation grafts in nipple reconstruction. Plast Reconstr Surg, 2016, 138(5): 936e-937e.
3. Gruber RP. Nipple-areola reconstruction: a review of techniques. Clin Plast Surg, 1979, 6(1): 71-83.
4. Egan KG, Cullom M, Nazir N, et al. Patient satisfaction increases with nipple reconstruction following autologous breast reconstruction. Plast Reconstr Surg, 2021, 148(2): 177e-184e.
5. Gougoutas AJ, Said HK, Um G, et al. Nipple-areola complex reconstruction. Plast Reconstr Surg, 2018, 141(3): 404e-416e.
6. Eo S, Kim SS, Da Lio AL. Nipple reconstruction with C-V flap using dermofat graft. Ann Plast Surg, 2007, 58(2): 137-140.
7. Elizabeth Clark S, Turton E. The CC-V flap: a novel technique for augmenting a C-V nipple reconstruction using a free dermal graft. World J Plast Surg, 2014, 3(1): 8-12.
8. Chia HL, Wong M, Tan BK. Nipple reconstruction with rolled dermal graft support. Arch Plast Surg, 2014, 41(2): 158-162.
9. Kurlander DE, Collis G, Bernard S. Autologous dermal fat graft modification for skate flap nipple reconstruction. J Plast Reconstr Aesthet Surg, 2016, 69(2): e44-e45.
10. 宋延刚, 李发成, 黄桂林. 星状皮瓣结合乳房真皮脂肪瓣乳头再造及乳房下皱襞重建的临床观察. 首都医科大学学报, 2019, 40(4): 656-660.
11. Temiz G, Yeşiloğlu N, Şirinoğlu H, et al. A New modification of C-V flap technique in nipple reconstruction: rolled triangular dermal-fat flaps. Aesthetic Plast Surg, 2015, 39(1): 173-175.
12. Bernard RW, Beran SJ. Autologous fat graft in nipple reconstruction. Plast Reconstr Surg, 2003, 112(4): 964-968.
13. Brent B, Bostwick J. Nipple-areola reconstruction with auricular tissues. Plast Reconstr Surg, 1977, 60(3): 353-361.
14. Tanabe HY, Tai Y, Kiyokawa K, et al. Nipple-areola reconstruction with a dermal-fat flap and rolled auricular cartilage. Plast Reconstr Surg, 1997, 100(2): 431-438.
15. Norton S, Akhavani MA, Kang N. The ‘Hamburger’ technique for harvesting cartilage grafts in nipple reconstruction. J Plast Reconstr Aesthet Surg, 2007, 60(8): 957-959.
16. Jones AP, Erdmann M. Projection and patient satisfaction using the “Hamburger” nipple reconstruction technique. J Plast Reconstr Aesthet Surg, 2012, 65(2): 207-212.
17. 崔军威, 刘晓岭, 杨子健, 等. 自体肋软骨支架乳头再造在乳房假体重建手术中的应用体会. 中华乳腺病杂志 (电子版), 2021, 15(4): 201-205.
18. Heitland A, Markowicz M, Koellensperger E, et al. Long-term nipple shrinkage following augmentation by an autologous rib cartilage transplant in free DIEP-flaps. J Plast Reconstr Aesthet Surg, 2006, 59(10): 1063-1067.
19. Lipa JE, Addison PD, Neligan PC. Patient satisfaction following nipple reconstruction incorporating autologous costal cartilage. Can J Plast Surg, 2008, 16(2): 85-88.
20. Guerid S, Boucher F, Mojallal A. Nipple reconstruction using rib cartilage strut in microsurgical reconstructed breast. Ann Chir Plast Esthet, 2017, 62(4): 332-335.
21. Tokumoto H, Akita S, Kosaka K, et al. Utilization of a partial rib-sparing procedure in microvascular breast reconstruction for preserving intercostal nerve and nipple reconstruction. J Plast Reconstr Aesthet Surg, 2022, 75(12): 4354-4360.
22. Guerra AB, Khoobehi K, Metzinger SE, et al. New technique for nipple areola reconstruction: arrow flap and rib cartilage graft for long-lasting nipple projection. Ann Plast Surg, 2003, 50(1): 31-37.
23. Cheng MH, Rodriguez ED, Smartt JM, et al. Nipple reconstruction using the modified top hat flap with banked costal cartilage graft: long-term follow-up in 58 patients. Ann Plast Surg, 2007, 59(6): 621-628.
24. Wolf O, Liu J, Legarda C, et al. The spare-parts technique: A safe and efficient single-stage nipple and areola reconstruction. J Plast Reconstr Aesthet Surg, 2020, 73(10): 1871-1878.
25. Dong X, Premaratne ID, Sariibrahimoglu K, et al. 3D-printed poly-4-hydroxybutyrate bioabsorbable scaffolds for nipple reconstruction. Acta Biomater, 2022, 143: 333-343.
26. Bhatty MA, Berry RB. Nipple-areola reconstruction by tattooing and nipple sharing. Br J Plast Surg, 1997, 50(5): 331-334.
27. Lee TJ, Noh HJ, Kim EK, et al. Reducing donor site morbidity when reconstructing the nipple using a composite nipple graft. Arch Plast Surg, 2012, 39(4): 384-389.
28. Sakai S, Taneda H. New nipple-sharing technique that preserves the anatomic structure of the donor nipple for breastfeeding. Aesthetic Plast Surg, 2012, 36(2): 308-312.
29. Wong AW, Chew KY, Tan BK. Two-blade guillotine technique for nipple graft harvest. Arch Plast Surg, 2017, 44(5): 449-452.
30. Tanaka Y. Tissue engineering treatment for the nipple-sharing donor site. Aesthetic Plast Surg, 2021, 45(6): 3083-3087.
31. Wraight WM, Davison JA. Nipple sharing for nipple-areolar complex reconstruction: still a useful technique. J Plast Reconstr Aesthet Surg, 2006, 59(12): 1471-1472.
32. Sisti A. Nipple-areola complex reconstruction. Medicina (Kaunas), 2020, 56(6): 296.
33. Holton LH, Haerian H, Silverman RP, et al. Improving long-term projection in nipple reconstruction using human acellular dermal matrix: an animal model. Ann Plast Surg, 2005, 55(3): 304-309.
34. Nahabedian MY. Secondary nipple reconstruction using local flaps and AlloDerm. Plast Reconstr Surg, 2005, 115(7): 2056-2061.
35. Garramone CE, Lam B. Use of AlloDerm in primary nipple reconstruction to improve long-term nipple projection. Plast Reconstr Surg, 2007, 119(6): 1663-1668.
36. Chen WF, Barounis D, Kalimuthu R. A novel cost-saving approach to the use of acellular dermal matrix (AlloDerm) in postmastectomy breast and nipple reconstructions. Plast Reconstr Surg, 2010, 125(2): 479-481.
37. Park GY, Yoon ES, Cho HE, et al. Acellular dermal matrix as a core strut for projection in nipple reconstruction: approaches for three different methods of breast reconstruction. Arch Plast Surg, 2016, 43(5): 424-429.
38. Hwang E, Yang JY, Ha HJ, et al. Nipple reconstruction using the semilunar flap and omega-shaped acellular dermal matrix strut. Aesthetic Plast Surg, 2022, 46(1): 152-160.
39. Kim EK, Lee TJ. Use of lyophilized allogeneic costal cartilage: is it effective to maintain the projection of the reconstructed nipple? Ann Plast Surg, 2011, 66(2): 128-130.
40. Demir Z, Velidedeoğlu H, Sahin U, et al. Preserved costal cartilage homograft application for the treatment of temporomandibular joint ankylosis. Plast Reconstr Surg, 2001, 108(1): 44-51.
41. Velidedeoğlu H, Demir Z, Sahin U, et al. Block and surgicel-wrapped diced solvent-preserved costal cartilage homograft application for nasal augmentation. Plast Reconstr Surg, 2005, 115(7): 2081-2093.
42. Strauch B, Wallach SG. Reconstruction with irradiated homograft costal cartilage. Plast Reconstr Surg, 2003, 111(7): 2405-2411.
43. Chang JS, Becker SS, Park SS. Nasal reconstruction: the state of the art. Curr Opin Otolaryngol Head Neck Surg, 2004, 12(4): 336-343.
44. Tierney BP, Hodde JP, Changkuon DI. Biologic collagen cylinder with skate flap technique for nipple reconstruction. Plast Surg Int, 2014, 2014: 194087. doi: 10.1155/2014/194087.
45. Collins B, Williams JZ, Karu H, et al. Nipple reconstruction with the biodesign nipple reconstruction cylinder: a prospective clinical study. Plast Reconstr Surg Glob Open, 2016, 4(8): e832.
46. Pashos NC, Graham DM, Burkett BJ, et al. Acellular biologic nipple-areolar complex graft: in vivo murine and nonhuman primate host response evaluation. Tissue Eng Part A, 2020, 26(15-16): 872-885.
47. Johnson PC, Klein GL. Orthotopic grafting of decellularized human nipple: Setting the stage and putative mechanism of healing. Breast, 2020, 54: 96-98.
48. Caronna VC, Rosenberg AF, Graham DM, et al. Viability of acellular biologic graft for nipple-areolar complex reconstruction in a non-human primate model. Sci Rep, 2021, 11(1): 15085.

Chinese Journal of Reparative and Reconstructive Surgery

Research progress in nipple projection reconstruction based on tissue graft support

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