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Preservation of Projection in Nipple Reconstruction Using Externally Scaffolded Autologous Costal Cartilage
RUNLEI ZHAO, Arash Samadi, Matthew Wright, Ishani Premaratne, Andrew Miller, Mariam Gadjiko, Alexandra Lin, Dianel Lara, Jaime Bernstein, Jason Spector.
Weill Cornell Medicine, New York, NY, USA.

Background: Nipple reconstruction is an essential and last step of breast reconstruction after total mastectomy, resulting in improved general satisfaction of patients. The most commonly used technique for nipple reconstruction utilizes local skin flaps. However, the neo-nipple created with this technique often loses a significant amount of projection over time. Herein we use specially processed patient-derived costal cartilage (CC), combined with custom designed biocompatible, biodegradable 3D-printed scaffolds to maintain the volume and contour of the neo-nipple over time.
Methods: Custom external scaffolds were designed and 3D-printed using polylactic acid (PLA). Patient derived CC was minced into approximately 2-3mm3 portions or flaked by processing with a zesting device. Half of the samples were packed into 3D-printed PLA scaffolds; in the remainder, an equal volume of processed cartilage was wrapped in Surgicel® only. The constructs were implanted into nude rats by creating a subcutaneous pocket using a CV flap technique. After 3 months, histological, topographical, biomechanical and gross analysis were performed. To measure volume and topography, constructs were imaged via computed tomography and then digitally reconstructed for measurement.
Results: After 3 months, gross analysis showed preservation of neo-nipple projection was significantly improved in the scaffold protected groups in comparison to unprotected groups (91.6% versus 64.1%, p=0.045). Similarly, volumetric analysis showed superior preservation of volume in the scaffolded groups in comparison to the unprotected groups (895.5mm3 versus 607.8mm3, p=0.019). Hematoxylin and eosin staining in both groups showed the presence of healthy and viable cartilage after 3 months in-vivo which was confirmed by LIVE/DEAD assay. Formation of fibrous tissue around the processed CC was noted in both groups. Furthermore, the resultant tissue was spongy and compressible much like a native nipple, with quantitative biomechanical studies currently underway.
Conclusions: We demonstrate that autologous CC, which is usually discarded during a DIEP procedure, can be processed and used as a viable implant for nipple reconstruction with favorable biomechanical qualities. Our 3D-printed biocompatible/biodegradable external scaffolds significantly mitigate loss of projection and contour of the neo nipples over the time.
Figure/Table:
(a) Costal cartilage specimen from patient was (b) minced and (c) wrapped in Surgicel ®, (d) place in 3D printed external scaffold and (e-h) implanted with or without PLA scaffolding on the dorsa of a nude rat


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