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Key Points
- Biologic acellular dermal matrixes are commonly used to achieve further stability of the reconstructed nipple
- Any biologic matrix can help achieve adequate vascularization of the tissue, expert says
- More than 20 products on the market can be used for tissue regeneration or reconstruction, but not all achieve equal surgical outcomes
Techniques used for nipple reconstruction surgery have evolved over the years, many of which now include the use of fillers and tissue-regenerative biologic matrixes. The reconstruction technique chosen, however, largely depends on the expertise of the surgeon and the specific cosmetic needs of the patient.
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Dr. Glasberg
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"The two main issues in nipple reconstruction that remain the limiting factors in terms of achieving good aesthetic outcomes are atrophy of the reconstructed tissue and lack of projection of the nipple in the long term," says Scot Bradley Glasberg, M.D., a cosmetic and reconstructive plastic surgeon in New York. "Not all techniques are equally effective, and choosing an appropriate, individualized approach for each patient is key in achieving good and long-lasting aesthetic outcomes."
RECONSTRUCTION OPTIONS Historically, nipple reconstruction has been challenging to perform. Surgical approaches range from skin grafting using tissue from the contralateral nipple, labia minora, pulp of the toe and earlobe with subsequent micropigmentation to color-match tissues, to more sophisticated techniques involving various kinds of pedicle flaps as well as fat grafting. All of these approaches can achieve good but varying aesthetic outcomes, and many are often combined in order to achieve the most optimal aesthetic result. Hyaluronic acid fillers and biologic matrixes are much newer modalities that can be used in nipple reconstruction, either alone or in combination with other techniques. Just as patients' aesthetic goals can differ from one another, however, so do the preferred reconstruction approaches chosen by surgeons.
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Dr. Carraway
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"The goal of nipple reconstruction is to create a papilla that can permanently maintain its shape and projection. Most nipple reconstruction techniques involve folding small skin flaps, like the petals of a flower, to create a prominent bud-like nipple that appears natural," says James H. Carraway, M.D., director, Plastic and Cosmetic Surgery Center of EVMS, Virginia Beach, Va. "These reconstructed nipples, however, need to be over-projected and made slightly larger, because they will shrink a bit over time and ideally will settle to a size in concordance with the aesthetic goal of the patient."
Should a given pedicle flap technique fall short of the patient's aesthetic goal, fillers such as Restylane (hyaluronic acid, Medicis) or Perlane (hyaluronic acid, Medicis) can supplement nipple rigidity and bolster surgically improved nipple projection. Ideally, filler treatment should be done in stages and injected gradually and progressively over time in order to better fine-tune the aesthetic result desired by the patient. Though the longevity of aesthetic outcomes may vary with fillers, Dr. Carraway says he believes that because the reconstructed nipple area is a relatively static region with a diminished blood supply, aesthetic results could last for years.
