Modified Skate Flap for Nipple-Areolar Reconstruction in 422 Implant Reconstructions: Technique and Outcome
Toni Zhong, MD, FRCSC1, Peter G. Cordeiro, MD, FACS2.
1Memorial Sloan Kettering Cancer Center, New York, NY, USA, 2memorial sloan kettering cancer center, new york, NY, USA.
Background: 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 long-term nipple projection with the use of “modified skate flap” technique in exclusively implant based post-mastectomy reconstructions.
Methods: A retrospective review was performed for the period between 1993 and 2007. All consecutive patients with two-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 one year follow-up were included in the study. Patients with a history of irradiation to the breast prior to NAR 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.
Results: Over the 15-year study period, 475 patients underwent two-staged tissue expander / implant reconstruction followed by nipple areolar reconstruction using the modified skate flap technique. Of these, a total of 292 patients completed the minimum requirement of one 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 2.5mm (range: 1-4mm). 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 non-take of the areola (2.1%).
Conclusions: This report documents the largest series of nipple areolar reconstructions using a single technique in the setting of post-mastectomy 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.