Augmentation de la projection du mamelon dans les reconstructions mammaires par injection de derme artificiel

Abstract

The reconstruction of the Nipple-Areola Complex (NAC) is the last step and a key part in breast reconstruction. The technique to be used should be chosen as to avoid any complications on previous reconstruction steps. The use of local flaps for NAC reconstruction could be associated with implant exposure especially in the presence of a history of radiation therapy. The pure dermal flap could be indicated for the nipple reconstruction after breast reconstruction by implant after radiotherapy. The limit stay in the nipple hypoprojection. We suggest to assess the increase of the nipple projection, reconstructed by pure dermal flap, by injection of Integra® Flowable Wound Matrix (Integra LifeSciences®, Plainsboro, New jersey). Nipple projection has been measured among patients enclosed from february to March 2016reconstructed by pure dermal flap: before, after and also at a 6months term from the injection of Integra® Flowable Wound Matrix. Patient satisfaction and complications have been measured retrospectively. Tenpatients with an average of 55years have been enclosed, with an average limit of time of 19months (7to 33months) between the breast nipple reconstruction by dermal flap and the injection. A volume of 1to 1.6cc has been injected. A significative increase projection of 2mm at a 6months term has been measured (1.5to 2.5mm, P<0.01), without complication and a satisfaction rate of 4.5/5. The injection of an artificial derm-like Integra® Flowable Wound Matrix seems to be efficient to increase the nipple projection reconstructed by pure dermal flap after a breast reconstruction and moreover, without complications.