- Email: [email protected]
Nipple reconstruction – Educating the patient
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P. Durani et al.
55. Crowe JM, Simpson K, Johnson W, et al. Reliability of photographic analysis in determining change in scar appearance. J Burn Care Rehabil 1998;19:183e6. 56. Smith GM, Tompkins DM, Bigelow ME, et al. Burn-induced cosmetic disfigurement: can it be measured reliably? J Burn Care Rehabil 1988;9:371e5. 57. Yeong EK, Mann R, Engrav LH, et al. Improved burn scar assessment with use of a new scar-rating scale. J Burn Care Rehabil 1997;18:353e5. 58. Quinn JV, Drzewiecki AE, Stiell IG, et al. Appearance scales to measure cosmetic outcomes of healed lacerations. Am J Emerg Med 1995;13:229e31. 59. Duncan JA, Bond JS, Mason T, et al. Visual analogue scale scoring and ranking: a suitable and sensitive method for assessing scar quality? Plast Reconstr Surg 2006;118:909e18. 60. Masters M, McMahon M, Svens B. Reliability testing of a new scar assessment tool, Matching Assessment of Scars and Photographs (MAPS). J Burn Care Rehabil 2005;26:273e84. 61. Singer AJ, Church AL, Forrestal K, et al. Comparison of patient satisfaction and practitioner satisfaction with wound appearance after traumatic wound repair. Acad Emerg Med 1997;4: 133e7.
62. Baker RA, Jones S, Sanders C, et al. Degree of burn, location of burn, and length of hospital stay as predictors of psychosocial status and physical functioning. J Burn Care Rehabil 1996;17: 327e33. 63. Crossland DS, Jackson SP, Lyall R, et al. Patient attitudes to sternotomy and thoracotomy scars. Thorac Cardiovasc Surg 2005;53:93e5. 64. Karlen LK, Yinusa W, Yan LS, et al. Analysis of scar formation after lower limb lengthening: influence on cosmesis and patient satisfaction. J Pediatr Orthop 2004;24:706e10. 65. Singer AJ, Mach C, Thode Jr HC, et al. Patient priorities with traumatic lacerations. Am J Emerg Med 2000;18:683e6. 66. Kearney CR, Holme SA, Burden AD, et al. Long-term patient satisfaction with cosmetic outcome of minor cutaneous surgery. Australas J Dermatol 2001;42:102e5. 67. Newton-Bishop JA, Nolan C, Turner F, et al. A quality-of-life study in high-risk (thickness >Z or 2 mm) cutaneous melanoma patients in a randomized trial of 1-cm versus 3-cm surgical excision margins. J Investig Dermatol Symp Proc 2004;9:152e9. 68. Mow CS, Woolson ST, Ngarmukos SG, et al. Comparison of scars from total hip replacements done with a standard or a miniincision. Clin Orthop Relat Res 2005;441:80e5.
CLINICAL TIP Nipple reconstruction e Educating the patient
Nipple reconstruction is for many oncological patients the last stage of an arduous and emotional surgical journey. We find it challenging to explain how we obtain a three dimensional (3D) structure from the two dimensional (2D) reconstructed breast surface when advocating local flap techniques. Our unit uses 3D foam model breasts in both the reconstruction and pre-assessment clinics to illustrate how the flap is harvested and how the nipple is subsequently fashioned (Figures 1 and 2). The flap can be fixed in position on the model by hand, tape or pins. This approach has reduced consultation time in clinic without compromising the quality and amount of information patients’ receive. We acknowledge Stuart Powell’s photographic expertise. Figure 2
Conflict of interest None. Daniel B. Saleh N.D. Rhodes Department of Plastic and Reconstructive surgery, Bradford Royal Infirmary, Duckworth Lane, Bradford BD9 6RJ, UK E-mail address: [email protected] Crown Copyright ª 2009 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons. All rights reserved.
Figure 1
doi:10.1016/j.bjps.2009.02.081
P. Durani et al.
55. Crowe JM, Simpson K, Johnson W, et al. Reliability of photographic analysis in determining change in scar appearance. J Burn Care Rehabil 1998;19:183e6. 56. Smith GM, Tompkins DM, Bigelow ME, et al. Burn-induced cosmetic disfigurement: can it be measured reliably? J Burn Care Rehabil 1988;9:371e5. 57. Yeong EK, Mann R, Engrav LH, et al. Improved burn scar assessment with use of a new scar-rating scale. J Burn Care Rehabil 1997;18:353e5. 58. Quinn JV, Drzewiecki AE, Stiell IG, et al. Appearance scales to measure cosmetic outcomes of healed lacerations. Am J Emerg Med 1995;13:229e31. 59. Duncan JA, Bond JS, Mason T, et al. Visual analogue scale scoring and ranking: a suitable and sensitive method for assessing scar quality? Plast Reconstr Surg 2006;118:909e18. 60. Masters M, McMahon M, Svens B. Reliability testing of a new scar assessment tool, Matching Assessment of Scars and Photographs (MAPS). J Burn Care Rehabil 2005;26:273e84. 61. Singer AJ, Church AL, Forrestal K, et al. Comparison of patient satisfaction and practitioner satisfaction with wound appearance after traumatic wound repair. Acad Emerg Med 1997;4: 133e7.
62. Baker RA, Jones S, Sanders C, et al. Degree of burn, location of burn, and length of hospital stay as predictors of psychosocial status and physical functioning. J Burn Care Rehabil 1996;17: 327e33. 63. Crossland DS, Jackson SP, Lyall R, et al. Patient attitudes to sternotomy and thoracotomy scars. Thorac Cardiovasc Surg 2005;53:93e5. 64. Karlen LK, Yinusa W, Yan LS, et al. Analysis of scar formation after lower limb lengthening: influence on cosmesis and patient satisfaction. J Pediatr Orthop 2004;24:706e10. 65. Singer AJ, Mach C, Thode Jr HC, et al. Patient priorities with traumatic lacerations. Am J Emerg Med 2000;18:683e6. 66. Kearney CR, Holme SA, Burden AD, et al. Long-term patient satisfaction with cosmetic outcome of minor cutaneous surgery. Australas J Dermatol 2001;42:102e5. 67. Newton-Bishop JA, Nolan C, Turner F, et al. A quality-of-life study in high-risk (thickness >Z or 2 mm) cutaneous melanoma patients in a randomized trial of 1-cm versus 3-cm surgical excision margins. J Investig Dermatol Symp Proc 2004;9:152e9. 68. Mow CS, Woolson ST, Ngarmukos SG, et al. Comparison of scars from total hip replacements done with a standard or a miniincision. Clin Orthop Relat Res 2005;441:80e5.
CLINICAL TIP Nipple reconstruction e Educating the patient
Nipple reconstruction is for many oncological patients the last stage of an arduous and emotional surgical journey. We find it challenging to explain how we obtain a three dimensional (3D) structure from the two dimensional (2D) reconstructed breast surface when advocating local flap techniques. Our unit uses 3D foam model breasts in both the reconstruction and pre-assessment clinics to illustrate how the flap is harvested and how the nipple is subsequently fashioned (Figures 1 and 2). The flap can be fixed in position on the model by hand, tape or pins. This approach has reduced consultation time in clinic without compromising the quality and amount of information patients’ receive. We acknowledge Stuart Powell’s photographic expertise. Figure 2
Conflict of interest None. Daniel B. Saleh N.D. Rhodes Department of Plastic and Reconstructive surgery, Bradford Royal Infirmary, Duckworth Lane, Bradford BD9 6RJ, UK E-mail address: [email protected] Crown Copyright ª 2009 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons. All rights reserved.
Figure 1
doi:10.1016/j.bjps.2009.02.081