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Surgical Outcomes and Nipple Projection Using the Modified Skate Flap for Nipple-Areolar Reconstruction in a Series of 422 Implant Reconstructions

Zhong, Toni MD, FRCS(C)*; Antony, Anu MD†; Cordeiro, Peter MD, FACS‡

doi: 10.1097/SAP.0b013e31819fb1c9
Northeastern Society of Plastic Surgeons

Numerous techniques have been used in an attempt to achieve long-term nipple projection following nipple-areolar reconstruction (NAR). A common setback, however, is the diminution of projection over time; this phenomenon is particularly evident following implant based breast reconstruction. The purpose of this report was thus to evaluate surgical outcomes and long-term nipple projection with the use of “modified skate flap” technique in exclusively implant based postmastectomy reconstructions.

A retrospective review was performed for the period between 1993 and 2007. All consecutive patients with 2-staged tissue expander/implant reconstructions followed by NAR using the modified skate flap technique performed by the senior author (P.C.) were identified in a prospectively maintained breast reconstruction database. Only patients with a minimum of 1-year follow-up were included in the study. Patients with a history of irradiation to the breast were excluded from nipple projection assessment. Clinical outcome measurements included long-term nipple projection as well as incidence of complications from the NAR procedure using the modified skate flap technique.

Over the 15-year study period, 475 patients underwent 2-staged tissue expander/implant reconstruction followed by NAR using the modified skate flap technique. Of these, there was a total of 292 patients with the minimum requirement of 1-year follow-up post NAR (61% follow-up rate). The total number of reconstructed nipple areolar complexes evaluated in this series was 422 (130 bilateral and 162 unilateral NAR). Forty patients (28 unilateral and 12 bilateral NAR) who received radiation to their breasts were excluded from nipple projection assessment. At a median follow-up of 44 months (range: 12–84 months), mean nipple projection was 2.5 mm (range: 1–4 mm). Minor complications occurred in 7.2% of the patients (n = 292). Skin graft donor site dehiscence was the most common complication (3.1%) followed by partial skin graft nontake of the areola (2.1%).

This report documents the largest series of NAR using a single technique in the setting of postmastectomy reconstructions. This technique can be safely performed over breast implants with acceptably low rates of complications and predictable results. Long-term nipple projection over implant reconstructions using this technique is modest and this must be forewarned to patients completing the final stage of their implant reconstruction.

From the *Breast Restoration Program, Division of Plastic and Reconstructive Surgery, Department of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada; †Division on Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA; and ‡Plastic and Reconstructive Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.

Received February 4, 2009 and accepted for publication, after revision, February 4, 2009.

Presented at the 25th Annual Meeting of the Northeastern Society of Plastic Surgeons, Philadelphia, PA, October 2008.

Financial Disclosure and Products: At no point was there any financial interest or commercial association linked to any of the authors in the manuscript preparation process.

Reprints: Peter Cordeiro, MD, FACS, Plastic and Reconstructive Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave., Room C-1193, New York City, NY 10021.

© 2009 Lippincott Williams & Wilkins, Inc.