Degree of satisfaction of women treated with reconstruction and dermopigmentation of the nipple-areola complex after breast reconstruction.

OBJECTIVE: To evaluate the degree of satisfaction of women treated with dermopigmentation and reconstruction of the Areola-Nipple Complex (ANC) after breast reconstruction, as well as their demographic profile and clinical-evolutionary characteristics. METHODS: Descriptive observational study including 128 women treated with dermopigmentation after oncologic breast reconstruction during 2018. In 2021 they were administered an adapted satisfaction questionnaire, which contains 27 items and categorizes satisfaction from 1-5, in addition other clinical-evolutionary and demographic variables were collected. RESULTS: Mean age was 51 (±9) years, 89.1% had previously undergone PDA reconstruction. Mean satisfaction with dermopigmentation was 4.4 (±0.88) and 3.79 (±1.06) for PDA reconstruction. Complications were rare, but 54.5% (n = 54) of the patients reported that the CAP reconstruction did not offer the expected projection, 91.6% (n = 98) that the color had faded and 51.4% (n = 55) would choose permanent tattooing. It was perceived that, the higher the satisfaction of the CAP, the higher the satisfaction of dermopigmentation, while the older the age and previous chemotherapy treatment the lower the color durability (p value ≤ 0.05). CONCLUSIONS: Patients who underwent reconstructive breast surgery show a high degree of satisfaction with dermopigmentation and surgical reconstruction of the PDA, but reiterate the low projecticity of the dermopigmentation and the surgical reconstruction of the PDA, but reiterate the low degree of satisfaction with the dermopigmentation.

Nipple Schwannoma: A Case Report and Literature Review on Nipple Mass.

Schwannomas are slow-growing benign tumors originating from the Schwann cells of the peripheral nerve sheaths. Herein, we report the first documented case of a schwannoma presenting as a painful nipple mass in a 32-year-old woman. This mass initially developed six years ago following a period of breastfeeding. Breast magnetic resonance imaging (MRI) scans revealed an iso-intense mass, with an approximate size of 2.2 cm, on a T1-weighted image with internal cystic changes. The mass exhibited heterogeneously delayed enhancement and restricted diffusion. Surgical excision was performed, and the diagnosis of cutaneous plexiform nipple schwannoma was confirmed histopathologically. A literature review revealed that the MRI findings of the nipple mass in our case were consistent with the common features of a schwannoma.

Initial nipple damages in breastfeeding women: analysis of photographic images and clinical associations / Lesiones tempranas del pezón derivadas de la lactancia materna: análisis de imágenes fotográficas y asociaciones clínicas / Lesões mamilares precoces decorrentes da amamentação: análise de imagens fotográficas e associações clínicas

ABSTRACT Objective: to analyze the initial nipple damage degree by breastfeeding practice and to associate findings with clinical manifestations of breastfeeding women. Methods: a retrospective, cross-sectional study with primary data and photographic images database from two randomized clinical trials. Photographic images were analyzed by two independent evaluators using the Nipple Trauma Score. For analysis, the chi-square, Mann-Whitney tests and Kappa coefficient were applied. Results: 115 breastfeeding women and their respective 186 photographic images were analyzed. The degree of agreement of evaluators using the Nipple Trauma Score was 93.6%. The nipple pain score during breastfeeding was moderate and compromised more than 25% of the nipple surface area. Conclusions: assistance to breastfeeding women should prioritize nipple pain intensity instead of the nipple damage size.

RESUMEN Objetivo: analizar el grado de afectación tisular en las lesiones tempranas del pezón resultantes de la lactancia materna y asociar los hallazgos con las manifestaciones clínicas de las mujeres que amamantan. Métodos: estudio retrospectivo, transversal, con datos primarios y banco de imágenes fotográficas de dos ensayos clínicos aleatorizados. Las imágenes fotográficas fueron analizadas por dos evaluadores independientes, utilizando el Nipple Trauma Score. Para el análisis se aplicaron las pruebas de Chi-Cuadrado, Mann-Whitney y coeficiente Kappa. Resultados: se analizaron 115 mujeres lactantes y sus respectivas 186 imágenes fotográficas. El grado de acuerdo de los evaluadores utilizando el Nipple Trauma Score fue del 93,6%. El nivel de dolor en el pezón durante la lactancia es moderado y existe presencia de lesiones del pezón con más del 25% de la superficie del pezón comprometida. Conclusiones: la asistencia a la mujer lactante debe priorizar el nivel de dolor que presenta en detrimento del tamaño de la lesión del pezón.

RESUMO Objetivo: analisar o grau de comprometimento tecidual das lesões mamilares precoces decorrentes da amamentação e associar achados com as manifestações clínicas de mulheres em amamentação. Métodos: estudo retrospectivo, transversal, envolvendo o uso de dados primários e de banco de imagens fotográficas provenientes de dois ensaios clínicos randomizados. Imagens fotográficas foram analisadas por duas avaliadoras independentes a partir do instrumento Nipple Trauma Score. Para análise, aplicou-se os testes Qui-Quadrado, Mann-Whitney e coeficiente Kappa. Resultados: foram analisadas 115 lactantes e respectivas 186 imagens fotográficas. O grau de concordância das avaliadoras pelo instrumento Nipple Trauma Score foi de 93,6%. O nível de dor mamilar encontrado durante as mamadas é moderado e há presença de lesões mamilares com mais de 25% de área da superfície do mamilo comprometida. Conclusões: a assistência a mulheres que amamentam deve priorizar o nível de dor apresentado em detrimento do tamanho da lesão mamilar.

Sun-Cross Running Suture Combined with Transverse to Longitudinal Skin Closure to Correct Severe Inverted Nipple.

BACKGROUND: Inverted nipple deformity presents an unsatisfactory appearance that may induce an unpleasant sex life, but can also be associated with psychological discomfort and increased the functional problems, such as local irritation and inflammation. METHODS: Multiple techniques have been used to correct inverted nipples, but they mostly lead to different problems such as deficiency of the nerve or duct, recurrence of the inverted nipple, and hypopigmented scars in the areola. To minimize complications and maintain the stability of the reconstructed nipple, we presented a minimal incision technique that designed four 3-mm-sized horizontal microincisions, which ran a sun-cross through the periphery and the core of the nipple to push the nipple together, then a vertical suture ran longitudinal to close the transverse incision to stabilize the projection. RESULTS: This technique was performed in 71 patients classified as grade II or III of the inverted nipples, comprising 53 congenital cases and 18 patients with acquired deformity. Thirty-four patients had bilateral inverted nipples, and 37 patients had unilateral inverted nipple. During a mean follow-up period of 15 months, 70 corrected nipples remained raised without recurrence, and one nipple was found retracted at the outpatient clinic after 3 months. There were no serious complications associated with surgery regarding nipple necrosis, seven patients got temporary swelling, two patients got infected after touching water, three patients got extravasated blood, eight patients indicated that they touched scar under the nipple, and two patients reflected nipple dysesthesia. In the 15 months follow-up, the patients with Grade II nipple inversion maintained a nipple average height of 9.54 ± 0.95, and the patients with Grade III nipple inversion maintained a nipple average height of 9.19 ± 1.09, and 86.63% of patients were satisfied with their results. CONCLUSION: This is a simple, safe, effective and reliable technique that should be considered, providing sustained results over the long-term follow-up period with a high rate of stable eversion and low incidence of ischemia, necrosis, scarring and dysesthesia. The vertical scar of the transverse incision closure leads to an esthetic appearance without apparent scarring and minimizes the risk of an altered nipple sensation. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Raynaud Phenomenon of the Nipple: A Clinical Case Report.

Objective: In Raynaud's phenomenon of the nipple there is a change in color, accompanied by pain or discomfort during breastfeeding. Case report: A 29-years old female patient, breastfeeding, develops a severe bilateral nipple pain during and after breastfeeding and biphasic change in nipple color, with difficulties in the breastfeeding technique. She was medicated with nifedipine and recommended application of warm compresses to the nipples and use of electric breast pump, showing complete resolution after four weeks of treatment. Conclusion: Raynaud's phenomenon of the nipple should be considered in breastfeeding women who report nipple pain or discomfort. In clinical practice, nipple pain is a very frequent complaint, and responsible for many cases of early abandonment of breastfeeding. It is therefore essential to make an early diagnosis and implement a correct and immediate treatment.

A Clinical Score For Predicting Complications Following Breast Reduction.

Objectives: To establish a clinical score for morbidity prediction based on patient-related risk factors after breast reduction surgery. Method: The retrospective study was conducted at the Department of Plastic and Reconstructive Surgery, Kafrelsheikh University Hospital, Egypt, and comprised data of female patients with bilateral macromastia who underwent breast reduction, using the inferior pedicle invertedT technique between February 2019 and June 2020. After data retrieval, risk factors and complications were documented and related to the patients'risk factors Data was analysed using SPSS 20. RESULTS: Of the 30 cases, 20(66.7%) were aged ≥35 years, 16(53.3%) had body massindex ≥37kg/m2 and 27(90%) were non-smokers. The mean preoperative haemoglobin level was 12.15±1.115g/dL and the mean weight of tissue resected on both sides was 2074.17±696.12gm. Factors significantly associated with complications included smoking, suprasternal notch to nipple distance ≥38cm, haemoglobin <12.5g/dL, the weight of excised tissue ≥2000gm and a positive family history of macromastia. The total score of the morbidity prediction scale ranged 2-190, with the best cut-off value being ≥93. The scale had 100% sensitivity,specificity, positive predictive value, negative predictive value and 100 percent accuracy. CONCLUSIONS: Ability to predict postoperative surgical-site morbidity may optimise safety as well as outcome after reduction mammaplasty.

Kajava Classification: The Person and the Research.

The Kajava classification for ectopic breast tissue is still widely used, although it was published in 1915 in Finnish. This historical note sheds light on the person and research behind the classification. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Bipedicled and structured mammoplasty "in three pillars" / Mamoplastia bipediculada e estruturada "em três pilares"

Introduction: Reduction mammoplasty has a long and established history. Since the end of the 19th century, numerous techniques for reducing and elevating breast tissue have been described, seeking the best aesthetic result and greater safety in relation to areolar vascularization and innervation. The purpose of the present study is to describe a new bipedicled and structured mammoplasty technique: safe, reproducible, with a fast-learning curve and predictable esthetic results. Methods: From January 2015 to August 2021, 86 patients underwent surgical treatment of mammoplasty using the technique in question. The analysis of the cases was carried out retrospectively through the evaluation of medical records and review of pre and postoperative photographs. Results: The support and projection achieved were lasting results. There were no hematomas or necrosis of the nipple-areola complex or other areas. Conclusion: The technique has high reproducibility, easy execution, high applicability and versatility, extremely satisfactory aesthetic and functional results for surgeon and patient, and above all, a high degree of safety.

Introdução: A mamoplastia redutora tem uma história longa e estabelecida. Desde o final do século XIX, foram descritas inúmeras técnicas para redução e elevação do tecido mamário, buscando não apenas o melhor resultado estético, como também maior segurança em relação a vascularização e inervação areolar. O presente estudo tem como propósito a descrição de uma nova técnica de mamoplastia bipediculada e estruturada: segura, reprodutível, de baixa curva de aprendizado e com resultados estéticos previsíveis. Método: De janeiro de 2015 a agosto de 2021, 86 pacientes foram submetidas ao tratamento cirúrgico de mamoplastia com a utilização da técnica em questão. A análise dos casos foi realizada de forma retrospectiva, através de avaliação de prontuários e revisão de fotografias de pré e pós-operatório. Resultados: A sustentação e projeção atingidas foram duradouras. Não houve ocorrência de hematomas ou necrose do complexo areolomamilar ou de quaisquer outras áreas. Conclusão: Tratase de uma técnica de alta reprodutibilidade, fácil execução, alta aplicabilidade e versatilidade, resultados estéticos e funcionais extremamente satisfatórios para cirurgião e paciente, além de, principalmente, um alto grau de segurança.

Traumas mamilares em nutrizes: revisão de escopo / Nipple trauma in nursing mothers: scope review

OBJETIVO: investigar, na literatura, a definição de trauma mamilar relacionado à amamentação, os tipos de trauma e seus tratamentos. MÉTODO: revisão de escopo. Foram consultados: PubMed; Literatura Latino Americana e do Caribe em Ciências da Saúde (LILACS); Cumulated Index to Nursing and Allied Health Literature (CINAHL); SCOPUS; Web of Science; Base de dados de enfermagem (BDENF), EMBASE e Biblioteca Cochrane. Incluídos estudos publicados de 2015 a 2020. RESULTADOS: a amostra final foi composta por 23 artigos, sendo que 14 deles abordaram a definição de trauma mamilar. Esse evento inclui dor, sendo um dos problemas mais comuns durante a amamentação e relevante fator para desmame precoce. A melhor forma de preveni-lo e tratá-lo é por meio de posicionamento e pega adequados. CONCLUSÃO: não há padronização quanto à definição de trauma mamilar e os diferentes tipos. Há necessidade de refinamento da nomenclatura, a fim de auxiliar no diagnóstico e tratamento adequados.

OBJECTIVE: to investigate the definition of nipple trauma related to breastfeeding, the types of trauma and their treatments in the literature. METHOD: scope review. The following were consulted: PubMed; Latin American and Caribbean Literature in Health Sciences (LILACS); Cumulative Index to Nursing and Allied Health Literature (CINAHL); SCOPUS; Web of Science; Nursing database (BDENF), EMBASE and Cochrane Library. Studies published from 2015 to 2020 were included. RESULTS: the final sample consisted of 23 articles, 14 of which addressed the definition of nipple trauma. This event includes pain, one of the most common problems during breastfeeding and a relevant factor for early weaning. Proper positioning and latch-on is the best way to prevent and treat it. CONCLUSION: there is no standardization regarding the definition of nipple trauma and the different types. There is a need for refinement of the nomenclature, in order to assist in the diagnosis and adequate treatment.

Effectiveness of Hoffman's Exercise in Postnatal Mothers With Grade 1 Inverted Nipples.

BACKGROUND: Breastfeeding provides perfect nutrition for infants. The inverted nipples in mothers make breastfeeding more challenging. Besides surgical approaches, non-pharmacological interventions are also gaining importance. RESEARCH AIM: To evaluate the effectiveness of Hoffman's exercise on breastfeeding among postnatal mothers with grade I inverted nipples. METHOD: A quantitative approach with a parallel arm randomized controlled trial was used in the study. Postnatal mothers were screened for inverted nipples using a pinch test. Participants with at least one inverted nipple (Grade 1) were randomly allocated into two groups: the experimental group (supported with Hoffman's exercise; n = 28, 50.9% ) and the control group (without Hoffman's exercise; n = 27, 49.1%). The pre-test data, including demographics, nipple length, and breastfeeding assessment, were collected. Breastfeeding assessment was evaluated using the Bristol Breastfeeding Assessment Tool (BBAT). On the 3rd day, the post-test data, including nipple length and Breastfeeding Assessment, were collected among the groups. RESULTS: The BBAT assessment was significantly higher in the post-test compared to that of the pre-test in the participants provided with Hoffman's exercise. The nipple length was found to be higher in participants provided with Hoffman's exercise. Furthermore, the variables-including age, gravida, nipple problems, and delivery type-were not found to have any significant effect with either pre-test or post-test levels of breastfeeding. CONCLUSIONS: Hoffman's exercise was found to be an effective method to improve breastfeeding in Grade 1 nipple-inverted among post-natal mothers. This nipple exercise is inexpensive, easy to follow, and results in the successful initiation of breastfeeding. CLINICAL TRIAL REGISTRY AND REGISTRATION NUMBER: CTRI/2019/05/019279, May 23, 2019 (retrospectively registered).

Procedure for correction of inverted nipple using tiny incision with primary breast ducts reserved / 中华医学美学美容杂志

Objective:To discuss the procedure for correction of inverted nipple using tiny incision with primary breast ducts reserved.Methods:A total of 35 patients (63 sides) with primary inverted nipples from January 2006 to March 2019 were reviewed retrospectively. Tiny radial incisions were made on the areola around the base of the inverted nipple which had been pulled out. Without skin removed, shorten fiber bundles which caused nipple inverted were totally cut and released. While the primary breast ducts were preserved, purse-string suture was taken around the base of the nipple. The nipple protector was prepared by ourselves, and the nipple was pulled and suspended for 2-6 months.Results:Sixty-three sides of 35 patients with inverted nipples were successfully corrected by this minimally invasive surgery. There was no nipple necrosis. One patient developed mild swelling 3 weeks after operation, and the swelling subsided after symptomatic anti-inflammatory treatment. The average follow-up period was 39 months. After removing the nipple protector, 2 sides (2/63) had a certain degree of recurrence. The rest of the nipples had ideal shape, no obvious scar, good nipple feeling, and retained the possibility of lactation.Conclusions:The procedure for correction of inverted nipple using tiny incision with primary breast ducts reserved has advantages of minimal invasion, safety, less pain, while retaining the possibility of lactation in the future. The clinical effect is satisfactory. It is especially suitable for the correction of type Ⅰ and type Ⅱ inverted nipples.

Somatic mosaicism in STAG2-associated cohesinopathies: Expansion of the genotypic and phenotypic spectrum.

STAG2 is a component of the large, evolutionarily highly conserved cohesin complex, which has been linked to various cellular processes like genome organization, DNA replication, gene expression, heterochromatin formation, sister chromatid cohesion, and DNA repair. A wide spectrum of germline variants in genes encoding subunits or regulators of the cohesin complex have previously been identified to cause distinct but phenotypically overlapping multisystem developmental disorders belonging to the group of cohesinopathies. Pathogenic variants in STAG2 have rarely been implicated in an X-linked cohesinopathy associated with undergrowth, developmental delay, and dysmorphic features. Here, we describe for the first time a mosaic STAG2 variant in an individual with developmental delay, microcephaly, and hemihypotrophy of the right side. We characterized the grade of mosaicism by deep sequencing analysis on DNA extracted from EDTA blood, urine and buccal swabs. Furthermore, we report an additional female with a novel de novo splice variant in STAG2. Interestingly, both individuals show supernumerary nipples, a feature that has not been reported associated to STAG2 before. Remarkably, additional analysis of STAG2 transcripts in both individuals showed only wildtype transcripts, even after blockage of nonsense-mediated decay using puromycin in blood lymphocytes. As the phenotype of STAG2-associated cohesinopathies is dominated by global developmental delay, severe microcephaly, and brain abnormalities, we investigated the expression of STAG2 and other related components of the cohesin complex during Bioengineered Neuronal Organoids (BENOs) generation by RNA sequencing. Interestingly, we observed a prominent expression of STAG2, especially between culture days 0 and 15, indicating an essential function of STAG2 in early brain development. In summary, we expand the genotypic and phenotypic spectrum of STAG2-associated cohesinopathies and show that BENOs represent a promising model to gain further insights into the critical role of STAG2 in the complex process of nervous system development.

Complication after nipple-areolar complex tattooing performed by a non-medical person: A case report.

BACKGROUND: Compared to earlier, there has been an increase in the tattoo procedures for cosmetic purposes; and there has also been an increase in the tattoo procedures performed by non-medical personnel. In South Korea, only tattoos performed by a doctor are considered legal; however, there is still some debate over whether tattoo procedures performed by non-healthcare providers should be considered legal. CASE SUMMARY: A 28-year-old woman visited our hospital with pain in both nipples and heat sensation over the last 4 d. She had a history of a nipple tattoo performed by an unlicensed person. Pinpoint bleeding was noted in both areolar areas, and the exudate mixed with pus and orange color ink was discharged. Oral medication and tulle with foam dressing were performed under the impression of cellulitis and allergic reaction. After 4 wk, nipples remained dark brown in color, resulting in a color mismatch between the nipple and orange-colored areola. The size of the areola was also found to be distinctly asymmetrical after healing. This complication may have been caused by the use of illegal ink or unsanitary procedures, or a problem may have occurred in the post-tattoo management stage. CONCLUSION: Doctors use approved ink, aseptic procedure and appropriate postoperative care, and appropriate management can be performed in case of complications.

Surgical treatment of nipple hypertrophy, nipple-areola symmetrization, and functional preservation - A systematic review.

Nipple hypertrophy is a rare deformity that affects women's self-esteem. Several surgical techniques have been described for its treatment, but there is no gold standard technique, leaving the choice to the surgeon based on preference. A systematic review was performed using PRISMA guidelines on the surgical treatment of nipple hypertrophy over the period available. An illustrative case series was also included with 24 women, mean age 34.5 years, with nipple hypertrophy, treated with a functional preservation technique. This consisted of the removal of a circular segment of nipple tissue between the base and the tip, preserving its central structures, in conjunction with breast surgeries. The nipple-areola complex also underwent a procedure to achieve a 1:3 ratio. Postoperative follow-up was 12 months for the metric assessment, occurrence of complications, and tactile and pain sensitivities. A total of 1,064 articles were found, but only 19 were eligible. Most studies were classified with a low evidence level, homogeneous series, without the possibility of meta-analysis. Regarding the case series, the measurements of the vertical and horizontal axes varied, on average, 1.4 and 1.25 cm, respectively, in the preoperative period. No changes in the sensitivity were reported. No women had any of local or systemic complications. All of them were followed for at least 12 months, with preservation of the nipple-areola metrics. There is a need for better scientific evidence regarding the surgical treatment of nipple hypertrophy. The present surgical technique demonstrated the long-term preservation of nipple metrics without sensory or functional impairment.

AOP key event relationship report: Linking androgen receptor antagonism with nipple retention.

In rat developmental and reproductive toxicity studies, nipple/areola retention (NR) in male offspring is a biomarker for reduced androgen signaling during development. This is because nipples normally regress in male rats in response to androgen signaling during critical stages of development. NR is thus included as a mandatory endpoint in several OECD test guidelines for assessment of chemicals, particularly as a readout for anti-androgenic effects relevant for reproductive toxicity. With the growing interest in developing Adverse Outcome Pathways (AOPs) to aid in chemical risk assessment, a more pragmatic approach has been proposed, whereby essential units of knowledge could be developed independently of complete AOPs, not least emergent key event relationships (KERs). Herein, we have developed a KER linking "androgen receptor antagonism" and "increased areola/nipple retention". The KER is based on a literature review conducted in a transparent semi-systematic manner in peer-reviewed databases with pre-defined inclusion criteria. Twenty-seven papers were included for development of the KER. The results support a qualitative relationship between the two key events (KEs) with a high weight of evidence; i.e., a causal relationship between androgen receptor (AR) antagonism and nipple retention in male rats exists.

Nipple ulcers of the nipple retractor technique to correct inverted nipples: A retrospective multivariate analysis.

BACKGROUND: A simple procedure using a nipple retractor to correct inverted nipples has been applied in clinical practice with stable and satisfactory aesthetic outcomes. Nipple ulceration and necrosis are rare and severe, with the causes unclear. OBJECTIVE: This study aimed to investigate the risk factors for the development of nipple ulcers in the nipple retractor technique. METHODS: A retrospective study was conducted on inverted nipple patients between January 2012 and September 2021. Clinical information, including baseline patient demographics, reproductive history, smoking, previous treatment, nipple inversion grades, nipple size, areola size, blood flow perfusion, and ulcer development, was collected. RESULTS: Twenty-five female patients with 44 inverted nipples were enrolled. Nipple ulcers were present in seven patients, four of whom were bilateral. Logistic regression analysis showed nipple inversion grades (Z = 2.105, OR 7.005, 95% CI: 1.144-42.898, p = 0.035) and relative perfusion of nipples (Z = -2.337, OR 0.969, 95% CI: 0.944-0.995, p = 0.019) were significantly associated with ulceration. The structural equation model demonstrated the interaction of related factors: nipple inversion grades increased by 0.411 points for ulcers (p = 0.004), while relative perfusion of nipples decreased by 0.647 points for ulcers (p < 0.001). CONCLUSION: Preoperative nipple inversion severity and post-operative nipple blood supply may be the risk factors for nipple ulcer development in the nipple retractor technique.

Single-stage buried autologous breast reconstruction (BABR).

BACKGROUND: Breast reconstructive standards are increasingly high oncologically, aesthetically, and practically. Autologous breast reconstruction remains the gold standard which, buried, after nipple-sparing mastectomy (where oncologically safe) or wise pattern reduction for large or ptotic patients, with contralateral symmetrisation where required, enables single-stage reconstruction. However, previous series report prohibitively high revision rates. This series prospectively compares a series of buried and non-buried free flaps for breast reconstruction. METHODS: All breast reconstructions with free autologous tissue transfer, buried or with a cutaneous paddle, conducted over 8 years by a single surgeon were included. Demographic, oncologic and reconstructive details, immediate complications and revision surgeries were recorded and compared between the two groups. RESULTS: A total of 182 free flaps were performed on 156 patients, 69 buried and 113 with cutaneous paddles. There were no significant demographic or complication differences between the two groups. Of the buried group, 51% did not require further surgery compared to 29% of the paddle group. CONCLUSIONS: Buried autologous breast reconstruction is a safe and aesthetic option for breast reconstruction, and potentially single stage. This is particularly true where it is combined with nipple-sparing mastectomy (where oncologically safe) or breast reduction mastectomy, and contralateral symmetrisation, where required. Further research could include patient reported outcome measures and cost analysis.

A Two-Step Technique for Correction of Severe Inverted Nipples with Minimally Invasive Procedures.

BACKGROUND: Congenital inverted nipple is not uncommon in Asian females, which impairs the patient's psychology and breastfeeding function. Although various methods have been reported in references, no consensus has been reached on an ideal treatment for severe inverted nipples. OBJECTIVES: This study aimed to propose a minimally invasive and reliable method that could correct severe inverted nipples, reduce their recurrence rate, and create a definite nipple neck for a natural shape. METHODS: We designed a two-step technique to correct severe inverted nipples, including congenital grade III inversion and recurrent grade III inversion with or without scar adhesion after correction with different methods from other hospitals. A retrospective study was performed on 38 patients (68 nipples) who underwent the new two-step technique in our department. The follow-up time was at least 6 months. Patient demographics, operation details, and complication rate were documented. RESULTS: A total of 68 nipples in 38 patients (bilateral: 30 patients; unilateral: 8 patients) received correction, among which there were four recurrent cases from other hospitals treated with different methods. In this study, the total recurrence rate was 7.89%. In these cases, the nipple exhibited the appearance of Grade I inversion, but not back to the preoperative state of Grade III. There was one case that suffered exposure of thread knot. CONCLUSIONS: The two-step technique is a minimally invasive method to successfully correct severe inverted nipples with a low recurrence rate and achieve a natural shape with a definite nipple neck. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Severe Bilateral Hyperkeratosis of the Nipples and Areolae: A Case Report and Literature Review.

Background: Hyperkeratosis of the nipple and areola (HNA) is a rare skin disease with unknown etiology. Some patients are misdiagnosed or never diagnosed, especially during the early stage of this disease. In addition, the mechanism involved in the development of HNA is still unknown, and genomic alterations have not been reported anywhere. Case Information: A 26-year-old female suffered gradual bilateral areola thickening and enlargement, with accompanying intense itching, and was diagnosed with HNA at the First Affiliated Hospital of Chongqing Medical University. No obvious abnormalities were found in laboratory test examinations such as hormone testing for estrogen, progesterone, or prolactin. Typical papillomatous skin with orthokeratotic hyperkeratosis and numerous infiltrating lymphocytes was detected through a histopathological examination. The results from RNA-sequencing showed that the molecular expression between HNA and a normal nipple and areola (NNA) was obviously different. No significant difference was found in the bilateral lesions. In addition, immune-related cell signaling pathways were overactivated in HNA compared to the control HNA. Conclusion: The typical symptoms, clinical features, and histopathological alterations presented in this case lead to a profound understanding of HNA, which can avoid the misdiagnosis and missed diagnosis of this disease at an early stage. The dysfunction of the local immune system, which was demonstrated by pathological examination and genomic analysis, suggests that anti-autoimmune therapy, such as steroid medication, may be an effective treatment for HNA at an early stage.