Use of AlloDerm in primary nipple reconstruction to improve long-term nipple projection.

BACKGROUND The objective of this study was to demonstrate the use of the authors' technique to improve long-term maintenance of nipple projection by using AlloDerm (LifeCell Corp., Branchburg, N.J.) as a central core in nipple reconstruction. METHODS The nipple reconstruction technique involved the use of a modified star dermal flap pattern measuring 5 cm in length and 1.0 to 1.5 cm in width, depending on the amount of desired projection to match the opposite nipple. Then, a 1.5 x 4.5-cm piece of AlloDerm was placed into the core of the newly reconstructed nipple and sutured closed. After the incisions were closed, an ocular eye bubble protector was used to prevent compressive forces on the newly reconstructed nipple, and strict postoperative use of this protector was maintained for 6 weeks. RESULTS A total of 30 nipple reconstructions were performed [14 transverse rectus abdominis musculocutaneous (TRAM) flaps and 16 tissue-expanded breast mounds]. Caliper measurements of nipple projection were recorded at the time of surgery and at 3, 6, and 12 months postoperatively. Twelve-month average maintenance of nipple projection was 56 percent for the TRAM flap group and 47 percent for the tissue-expanded group. There were no infections or associated complications. CONCLUSIONS The authors' results demonstrate that the use of a modified star dermal flap pattern with the placement of an AlloDerm graft core is a safe, easily performed, and reproducible technique for improving the long-term maintenance of projection in reconstructed nipples.