Dr. Nastala Weighs In On Nipple Reconstruction Study

By: Courtney Floyd


Is the use of the Biodesign Nipple Reconstruction Cylinder necessary during nipple reconstruction after mastectomy? 

A recent study published in the Plastic and Reconstructive Surgery Journal examined the use of the Biodesign Nipple Reconstruction Cylinder (NRC) during reconstruction of the nipple after a mastectomy and breast reconstruction. In this study, the NRC with placed beneath small skin flaps as a stent to help recreate a nipple. Nipple projections was measured for a year after surgery and patient satisfaction was measured.

For more insight into this procedure, I asked Dr. Chet Nastala to weigh in. Here is what he had to say:

“Interesting study. Nipple reconstruction is the last step in the breast reconstruction process. Most of our patients are extremely satisfied with the results of their nipple reconstruction and complications such as total nipple loss are very rare (1 to 2% or less).

The major issue with nipple reconstruction is a lack of projection. The reason for lack of projection is nipple reconstructions are typically done by rearranging the skin with a bowtie or other type of flap. There is essentially no scaffolding or framework to maintain long term projection. Typically, we tell patients projections will decrease by 50 to 60%. That also seems to be the case in the study (starting out at 10 mm postop and then about 4 mm projection at one year). That's pretty typical, but once the tattooing is performed the overall cosmetic results are very good and patients are very pleased despite this loss of projection.

The major problem with nipple reconstruction is there is no sensation in the skin because the underlying breast is removed. Typically, the DIEP flaps provide a much better foundation on which to build a proper nipple reconstruction. When patients have implant reconstruction the skin can be quite thin over the implant and nipple reconstruction can be hard to do to gain any projection. In that case, many patients just choose an "illusion" tattoo.

I believe overall our nipple reconstruction results are excellent as you can see in our before and after photos and based on our patient satisfaction survey results. I would like to add 3-D printing could be the future of nipple reconstruction, but a lot of more research needs to be done to see if it adds anything to the existing techniques. I would think it would show great promise if you could culture patient's skin cells and build or print the nipple with layers including an epidermis and just grafted on without a surgical procedure.”

For more details on how nipple reconstruction using the bow-tie method is performed, check out this video of Dr. Peter Ledoux walking us through a live procedure! 

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