A New Technique in Nipple Reconstruction: An Innovated Nipple Protector Following Two-Stage Modified Top-Hat Flap with Auricular Cartilage Struts

Background

Nipple reconstruction is an essential component of an attractive rebuilt breast. However, postoperative shrinkage of reconstructed nipples is a common problem, even with graft of rib cartilage. This is especially true in Asian women who usually have large nipples with small areola. This report described a two-stage reconstruction of nipple using auricular cartilage struts buried in the dermis of delayed local flaps. We used cartilage struts instead of a block to keep the nipple softer and elastic. We also innovated a method to measure the nipple volume in order to compare the shrinkage rates. Besides, we created nipple protectors for post-operative wound care and prevention of compression.

Material and Methods

During 2011-2013, we have done 24 nipple reconstructions with modified top hat flap with auricular cartilage graft following breast reconstruction in 14 autologous tissue and 10 expander-implant reconstructions. We first buried cartilage struts (usually 5 in number) from ear in the lower dermis of delayed local flaps. After 2-3 weeks of delay, the flaps were elevated and the buried cartilage served as supporting columns in the wall of reconstructed nipples. Then, we apply the impression material, Panasil® initial contact x-light, to the newly-formed nipple and make the nipple imprint. We fill this imprint with plaster to make a nipple cast. Then we use this cast to make Copyplast® mold, by a pressing machine, Biostar®. This mold is transparent, elastic and strong enough to protect the nipple from friction. We fill this mold with water and get the weight to measure the nipple volume.

Results

With this method, the reconstructed nipples were all viable. Postoperatively and during 3 to 6 months follow-up, we used this method to measure the volume of rebuilt nipple more precisely. The shrinkage rate was around 31% in height and 44% in volume. By precise measurement, we can compare different methods of nipple reconstructions later. In addition, we applied these nipple protectors to our patients to facilitate post-operative wound care and bring satisfaction to our patients.

Conclusions

Here we provided a new method of nipple reconstruction by modified top-hat flap with auricular cartilage struts. In addition, we innovated a nipple protector which can benefit post-operative wound care and prevent the newly-formed nipple from compression.