[Long-term results after reconstruction of the nipple-areola complex]. / Langzeitergebnisse nach Rekonstruktion des Mamillen-Areola-Komplexes.

The reconstruction of the nipple-areola complex (NAC) is an aesthetically and psychosocial important final step in breast reconstruction. While numerous publications examine the long-term results using various techniques to reconstruct the nipple, to our knowledge there have been few studies on the long-term results after areolar reconstruction. The study therefore examines the long-term results after areola reconstruction in women with autologous breast reconstruction. In the period 2014-2016 we performed NAC reconstructions in 126 patients in our clinic. The areola was reconstructed by full skin transplantation from the groin or upper eyelids. A total of 27 women with a median age of 52 ± 8.6 years after a median period of 1.7 ± 0.7 years were examined with regard to colour change, size change and satisfaction with the reconstruction result of the MAK. The results showed a noticeable colour fading with good satisfaction of the patients with the result. We observed an increase in the size of the neoareoles by an average of 13,9 percent with full skin from the groin and 34,6 percent with full skin from the upper eyelids. Patients should be informed preoperatively of colour fading and size changes of the neo-areola.

Coating decellularized equine carotid arteries with CCN1 improves cellular repopulation, local biocompatibility, and immune response in sheep.

Decellularized equine carotid arteries (dEAC) are potential alternatives to alloplastic vascular grafts although there are certain limitations in biocompatibility and immunogenicity. Here, dEAC were coated with the matricellular protein CCN1 and evaluated in vitro for its cytotoxic and angiogenic effects and in vivo for cellular repopulation, local biocompatibility, neovascularization, and immunogenicity in a sheep model. CCN1 coating resulted in nontoxic matrices not compromising viability of L929 fibroblasts and endothelial cells (ECs) assessed by WST-8 assay. Functionality of CCN1 was maintained as it induced typical changes in fibroblast morphology and MMP3 secretion. For in vivo testing, dEAC±CCN1 (n=3 each) and polytetrafluoroethylene (PTFE) protheses serving as controls (n=6) were implanted as cervical arteriovenous shunts. After 14 weeks, grafts were harvested and evaluated immunohistologically. PTFE grafts showed a patency rate of only 33% and lacked cellular repopulation. Both groups of bioartificial grafts were completely patent and repopulated with ECs and smooth muscle cells (SMCs). However, whereas dEAC contained only patch-like aggregates of SMCs and a partial luminal lining with ECs, CCN1-coated grafts showed multiple layers of SMCs and a complete endothelialization. Likewise, CCN1 coating reduced leukocyte infiltration and fibrosis and supported neovascularization. In addition, in a three-dimensional assay, CCN1 coating increased vascular tube formation in apposition to the matrix 1.6-fold. Graft-specific serum antibodies were increased by CCN1 up to 6 weeks after implantation (0.89±0.03 vs. 1.08±0.04), but were significantly reduced after 14 weeks (0.85±0.04 vs. 0.69±0.02). Likewise, restimulated lymphocyte proliferation was significantly lower after 14 weeks (1.78±0.09 vs. 1.32±0.09-fold of unstimulated). Thus, CCN1 coating of biological scaffolds improves local biocompatibility and accelerates scaffold remodeling by enhancing cellular repopulation and immunologic tolerance, making it a promising tool for generation of bioartificial vascular prostheses.