Improving Long-Term Projection in Nipple Reconstruction Using a New Human-Derived Acellular Dermal Matrix: Dermal matrix for nipple

Background: Loss of projection is a very common complaint after nipple reconstruction. In this paper, we present our experience with the use of a novel human cadaver-donor-derived acellular dermal matrix, named MODA (Matrice Omologa Dermica Acellulata) from the Regional Skin Bank to improve and stabilize nipple projection after oncoplastic breast surgery. Methods: We did a retrospective analysis of patients undergoing nipple reconstruction with local flap and MODA graft after breast reconstruction between February 2019 and May 2021. The analysis was done following the Declaration of Helsinki and was approved by the ethics committee; written consent was sought from all the participants. The main evaluation criterion was nipple projection measurement, performed immediately after surgery, 6 and 12 months postoperatively. The secondary endpoints were complications and patients’ satisfaction. Results: In this study, 50 patients underwent nipple reconstruction, with 57 reconstructed nipples. All cases except six followed delayed breast reconstruction. The patients were divided into 3 groups, according to the breast reconstructive technique. There were three cases of delayed wound healing and two cases of partial necrosis, but all of the cases healed by secondary intention. Five percent of the patients (3/57 reconstructions) presented more than 60% of nipple projection loss and required another procedure. The other reconstructed nipples maintained an average of over 60% projection after 12 months. Conclusion: The described technique presents a high success rate associated with low complications. Indeed, it provides the advantages of nipple reconstruction with ADM with low costs, appears safe after radiotherapy, and has similar results when used after different reconstructive techniques.