Breast Splint for Prevention of Nipple–Areolar Complex Malposition After Direct-to-Implant Breast Reconstruction

Yoshihiro Sowa, MD, PhD; Takuya Kodama, MD; Yuko Fuchinoue, MD; Naoki Inafuku, MD; Yasunobu Terao, MD, PhD

Disclosures

Plast Reconstr Surg Glob Open. 2022;10(1):e3965 

In This Article

Methods

A hydrocolloid dressing (DuoActive CGF, Convertex, UK) was used as the material for the breast splint, starting in cases treated in April 2020. This material is generally used as a dressing for skin defect wounds that extend to the subcutaneous tissue. It was selected as a sealant material because it is adhesive and can be used through sticking only, has sufficient firmness to prevent skin shortening, and has cushioning properties to prevent pressure injury. In the procedure, the distance from the midpoint of the clavicle to the nipple is measured in the sitting position before surgery. A splint is cut at the same length and 20-cm width. Before the beginning of negative pressure on the suction drain at the end of surgery, the skin envelope over the breast implant is pinched up along with the pectoralis major muscle and pulled caudally. Then, immediately after the suction is started, the splint is attached to the breast skin from the lower edge of the clavicle to the nipple at the surgical site. (See Video [online], which displays the procedure for installing the breast splint shown in the photographs from left to right.) The breast splint is set before starting suction pressure to avoid wrinkling of the skin in the area to which it is applied. To protect against skin damage associated with prolonged fixation, use of a skin barrier cream or spray, such as Cavilon Barrier Cream (3M), is recommended. It takes approximately 1 month for the skin and pectoral muscles to adhere, and thus, 1 month is the standard period for attachment of the breast splint. During the hospitalization period, if the CGF develops prominent wrinkles or loses its adhesiveness, it is strongly recommended to be replaced with a new CGF as needed. Furthermore, this replacement should be continued even during each of the weekly outpatient visits. For evaluation of the symmetry of the NAC, a bad result was defined as a case in which the horizontal line of the most caudal edge of the areolar on the affected side exceeded the height of most cephalad edge of the nipple on the healthy side.[4] The symmetry results of the left and right NACs in the nine patients who received breast splints were compared with that in 15 consecutive patients who did not receive breast splints by April 2020. Patients with BRCA or who underwent RRM were not enrolled in this study. Patient demographics in this study are shown in Table 1.

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