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.
Humans ; Adipose Tissue ; Autografts ; Costal Cartilage ; Nipples/surgery* ; Transplants

Objective: To examine the outcome of different incision selection for nipple-sparing mastectomy (NSM) with implant-based breast reconstruction (IBBR). Methods: Ninety-Two cases accepted NSM and IBBR from totally 1 002 cases of breast cancer admitted to Beijing Tongren Hospital Affiliated to Capital Medical University from June 2013 to December 2020 were analyzed retrospectively. All the patients were female, aging (42.0±7.5) years (range: 27 to 64 years). There were 12 patients at stage 0, 47 patients at stage Ⅰ, 17 patients at stage Ⅱ, and 16 patients at stage Ⅲ. The patients were divided in three groups by the incision: peri-areolar group (n=23), inframammary group (n=33) and lateral group (n=36). The age, tumor size, lymph node status, hormone receptor, operation method and postoperative complications were followed-up of three groups and compared by one-way ANOVA, χ² test or Fisher's exact test and expansion to comparied. Results: There was no significant difference in operation time ((180.7±54.0) minutes vs. (176.9±48.1) minutes vs. (194.6±37.5) minutes, F=1.401, P=0.252), postoperative drainage volume ((497.5±226.0) ml vs. (495.4±182.5) ml vs. (519.8±172.0) ml, F=0.167, P=0.846) and drainage time ((8.8±3.8) days vs. (8.0±2.5) days vs. (8.3±2.9) days, F=0.542, P=0.583) among the peri-areolar, inframammary, and lateral groups. The cumulative postoperative complications were relatively higher in the peri-areola group (26.1%(6/23) vs. 0 vs.8.3%(3/36), χ²=9.675, P=0.004). All female patients were followed up for (49.0±25.6) months(range: 12 to 112 months). Breast cancer related death rate was 2.2% (2/92), local recurrence was 1.1% (1/92), regional recurrence was 4.3% (4/92), distant metastasis was 6.5% (6/92), and the disease-free survival rate was 88.0% (81/92). Conclusion: The surgical effects of the peri-areolar, inframammary and lateral incisions for NSM and IBBR are approximate, the total complication rate of the peri-areolar incision is slightly higher.
Breast Neoplasms/pathology* ; Female ; Humans ; Mammaplasty/methods* ; Mastectomy/methods* ; Nipples/surgery* ; Retrospective Studies

Objective: To explore the surgical strategy of nipple areola complex (NAC) management in central breast cancer. Methods: A retrospective analysis was conducted on 164 cases of central breast cancer who underwent surgery treatment from December 2017 to December 2020 in the Breast Center of Beijing Tongren Hospital, Capital Medical University. Prior to the surgery, the tumor-nipple distance (TND) and the maximum diameter of the tumor were measured by magnetic resonance imaging (MRI). The presence of nipple invagination, nipple discharge, and nipple ulceration (including nipple Paget's disease) were recorded accordingly. NAC was preserved in patients with TND≥0.5 cm, no signs of NAC invasion (nipple invagination, nipple ulceration) and negative intraoperative frozen pathological margin. All patients with signs of NAC involvement, TND<0.5 cm or positive NAC basal resection margin confirmed by intraoperative frozen pathology underwent NAC removal. χ(2) test or Fisher exact test was used to analyze the influencing factors. Results: Of the 164 cases of central breast cancer, 73 cases underwent breast-conserving surgery, 43 cases underwent nipple-areola complex sparing mastectomy (NSM), 34 cases underwent total mastectomy, and the remaining 14 cases underwent skin sparing mastectomy (SSM). Among the 58 cases of NAC resection (including 34 cases of total mastectomy, 14 cases of SSM, and 10 cases of breast-conserving surgery), 25 cases were confirmed tumor involving NAC (total mastectomy in 12 cases, SSM in 9 cases, and breast-conserving surgery in 4 cases). The related factors of NAC involvement included TND (P=0.040) and nipple invagination (P=0.031). There were no correlations between tumor size (P=0.519), lymph node metastasis (P=0.847), bloody nipple discharge (P=0.742) and NAC involvement. During the follow-up period of 12 to 48 months, there was 1 case of local recurrence and 3 cases of distant metastasis. Conclusions: For central breast cancer, data suggest that patients with TND≥0.5cm, no signs of NAC invasion (nipple invagination, nipple ulceration) and negative NAC margin in intraoperative frozen pathology should be treated with NAC preservation surgery, whereas for those with TND<0.5 cm or accompanied by signs of NAC invasion, NAC should be removed. In addition, nipple reconstruction can be selected to further improve the postoperative appearance of patients with central breast cancer.
Breast Neoplasms/surgery* ; Female ; Humans ; Mammaplasty/methods* ; Mastectomy/methods* ; Nipples/surgery* ; Retrospective Studies

BACKGROUND: Mastectomy techniques have been extended to nipple-sparing mastectomy (NSM). This study aimed to assess the actual application of NSM in China and identify the factors influencing postoperative complications. METHODS: The clinical data of 615 patients (641 surgeries) undergoing NSM from January 1st, 2018 to December 31st, 2018 at 28 centers nationwide were retrospectively analyzed to obtain the rate of NSM and investigate factors related to NSM surgery. RESULTS: The proportion of NSM surgery performed in this study was 2.67% (17/641). Malignant breast tumors accounted for the majority of NSM surgery (559/641, 87.2%). A total of 475 (77.3%) patients underwent NSM combined with reconstructive surgery. The rate of reconstruction decreased with age in our study, and implants were the most common option (344/641, 53.7%) in reconstruction. Radial incision was the most selected method regardless of reconstruction. However, for those who underwent reconstruction surgery, 18.4% (85/462) of cases also chose curvilinear incision, while in the simple NSM surgery group, more patients chose circumareolar incision (26/136, 19.1%). The tumor-to-nipple distance (TND) influenced postoperative complications (P = 0.004). There were no relationships between postoperative complications and tumor size, tumor location, histologic grade, molecular subtype, nipple discharge, and axillary lymph nodes. CONCLUSIONS: NSM surgery is feasible and only TND influenced postoperative complications of NSM surgery. But the proportion of NSM surgery performed is still low in nationwide centers of China. The selection criteria for appropriate surgical methods are important for NSM in clinical practice. To optimize clinical applications of NSM, further multicenter prospective randomized controlled studies are needed. TRIAL REGISTRATION ChiCTR.org.cn, ChiCTR1900027423; http://www.chictr.org.cn/showprojen.aspx?proj=38739.
Breast Neoplasms/surgery* ; China ; Humans ; Mammaplasty ; Mastectomy ; Nipples/surgery* ; Prospective Studies ; Retrospective Studies

Necrosis of nipple-areola complex is one of the major complications of breast reduction in gigatomastia. We present a case study of a 32-year-old patient with severe gigantomastia, who required an immediate nipple reconstruction during breast reduction. The final reconstruction was satisfactory. No complications were observed within three months postoperatively.
Adult ; Breast/surgery* ; Female ; Humans ; Hypertrophy/surgery* ; Mammaplasty/methods* ; Nipples/surgery* ; Surgical Flaps ; Treatment Outcome

To investigate the experience and efficacy of endoscopic thyroidectomy for papillary thyroid microcarcinoma (PTMC) through total areola approach.
 Methods: A total of 117 PTMC patients, who were diagnosed pathologically in Minimally Invasive Surgical Center, Second Xiangya Hospital, Central South University from June 2016 to December 2017, were divided into a endoscopic surgery group (n=72) and an open surgery group (n=45). The number of dissected central lymph nodes, blood loss, amount of drainage, occurrence of postoperative complication and recurrence were collected and compared.
 Results: Compared with the open surgery group, the blood loss was less and the operative time was longer in the endoscopic surgery group (P<0.05). There were no significant differences between the 2 groups in the number of dissected central lymph nodes, amount of drainage and occurrence of postoperative complication (all P>0.05). The mean follow-up time was more than 20 months, and there was no recurrence in the 2 groups. 
 Conclusion: Endoscopic thyroidectomy with central compartment neck dissection through total areola approach is safe and feasible in patients with PTMC. It has many advantages, such as no scar on neck, less blood loss, shorter hospital stay and more acceptable to young patients.
Carcinoma, Papillary ; surgery ; Endoscopy ; Humans ; Nipples ; Thyroid Neoplasms ; surgery ; Thyroidectomy

BACKGROUND: Nipple-areolar complex (NAC) reconstruction following curative mastectomy is traditionally performed as a second-stage procedure several months after initial breast reconstruction. The recent literature has documented the increasing popularity of immediate nipple reconstruction carried out simultaneously during autologous reconstruction. The aim of this study was to evaluate the surgical outcomes and patient satisfaction with immediate breast and nipple reconstruction performed in a single stage after skin-sparing mastectomy. METHODS: All patients who underwent a skin-sparing mastectomy with immediate latissimus dorsi flap breast and NAC reconstruction as a single-stage procedure from 2007 to 2015 were included. Patient demographics, oncologic details, and surgical outcomes were recorded. The BREAST-Q questionnaire was administered to patients to assess the impact and effectiveness of this reconstructive strategy. RESULTS: During the study period, 34 breast and NAC reconstructions in 29 patients were performed at Cork University Hospital. The majority of our patient cohort were non-smokers (93.1%) and did not receive adjuvant radiotherapy. Postoperative complications were infrequent, with no cases of partial necrosis or complete loss of the nipple. The response rate to the BREAST-Q was 62% (n=18). Patients reported high levels of satisfaction with the reconstructed breast (62±4), nipple reconstruction (61±4.8), overall outcome (74.3±5), and psychosocialwell-being (77.7±3.2). CONCLUSIONS: Skin-sparing mastectomy with immediate nipple reconstruction during autologous latissimus dorsi reconstruction was demonstrated to be a safe and aesthetically reliable procedure in our cohort, yielding high levels of psychological and physical well-being. A single-stage procedure promotes psychosocial well-being involving issues that are intrinsically linked with breast cancer surgery.
Breast Neoplasms ; Breast* ; Cohort Studies ; Demography ; Female ; Humans ; Mammaplasty* ; Mastectomy* ; Necrosis ; Nipples* ; Patient Satisfaction* ; Postoperative Complications ; Radiotherapy, Adjuvant ; Reconstructive Surgical Procedures ; Superficial Back Muscles* ; Surgery, Plastic

OBJECTIVETo investigate the trans-areola approach for costicartilage harvesting in order to avoid the obvious scar resulted by traditional approach through chest incision.

METHODSFrom 2013, 7 cases who underwent rhinoplasty received costicartilage harvesting through trans-areola approach. The incision was designed along the lower interior edge of right areola. Then the dissection was performed to expose the 5th costicartilage. Then a costicartilage, 2 - 5 cm in length, was harvested. The incision was closed delicately. The suture was removed 7 days after operation.

RESULTSThe patients were followed up for 3 months to 2 years without hypertrophic scar and breast deformity. The scar was located in conceal location. The satisfactory rate was higher than that in patients with chest incision.

CONCLUSIONSThe scar resulted from trans-areola approach is comparatively conceal, compared with that at chest.

Breast ; surgery ; Cicatrix ; pathology ; Costal Cartilage ; Dissection ; methods ; Female ; Follow-Up Studies ; Humans ; Nipples ; surgery ; Rhinoplasty ; methods ; Time Factors ; Tissue and Organ Harvesting ; methods ; Transplant Donor Site

Adult ; Breast Neoplasms ; diagnosis ; metabolism ; surgery ; Female ; Humans ; Nipples ; pathology ; surgery ; Ultrasonography ; methods

OBJECTIVETo investigate the application of combining mastopexy and triple-plane breast augmentation in correction of breast ptosis and atrophy.

METHODSPeri-areolar incision was performed to finish the fascia and dermal suspension to correct the breast ptosis. The implant was inserted under the pectoralis major muscle through lateral lower border of the gland and a "X" shape full thickness incision was made on the pectoralis major muscle according to the new position of nipple-areolar complex.

RESULTS14 patients received combined mastopexy and triple-plane breast augmentation to correct breast atrophy and mastopexy simultaneously. All the patients were regularly followed for 6-12 months. No patients suffered severe complication and the results were satisfied.

CONCLUSIONS"Triple-plane" breast augmentation could be safely performed with peri-areolar mastopexy with minor injury. The technique could help to ensure the balance between the gland, nipple-areolar complex and the implant.

Atrophy ; surgery ; Breast ; pathology ; surgery ; Breast Implantation ; methods ; Female ; Humans ; Mammaplasty ; methods ; Nipples ; pathology ; surgery ; Pectoralis Muscles ; surgery