BACKGROUND
Reconstructed breast without nipple is called a breast mound. Nipple reconstruction completes the breast reconstruction. However, dressing following newly reconstructed nipple remains problematic. An ideal dressing should protect the nipple, absorb wound exudates, maintain good airflow and, most importantly, the nipple must be visible for inspection. We describe a dressing technique using cartella eye-shield which is cheap and satisfies all the above mentioned criteria.
TECHNIQUE
Cartella eye-shield1,2 is a transparent plastic shield, used to protect the eye after operations. We use BD Visitec™ (Becton, Dickinson and Company, Waltham, MA 02452, USA) universal eye shield (Fig. 1) to dress the reconstructed nipple. The breast (Fig. 2) is covered with gauze, with a hole in the centre (Fig. 3) to accommodate the neo-nipple. The thickness of the gauze is adjusted according to the height of the nipple; Visitec™ sterile eye-shield is placed over the hole (Fig. 4) and secured with adhesive tape (Fig. 5).
Figure 1.
Transparent cartella eye-shield (Visitec™).
Figure 2.
Skin sparing mastectomy with immediate breast and nipple reconstruction has been performed.
Figure 3.
Sterile gauze with a hole cut out in the centre to accommodate the reconstructed nipple.
Figure 4.
Reconstructed breast is covered with sterile gauze followed by transparent cartella eye-shield over the reconstructed nipple-areola.
Figure 5.
The gauze and cartella eye shield are secured in place with soft adhesive tape.
DISCUSSION
Cartella dressing allows clear visibility of flap colour, costs approximately 40 pence each and is cheaper than a 6” × 8” or 8” × 12” transparent film dressing commonly used. The gauze absorbs wound exudates while the dome shaped eye-shield protects reconstructed nipple. The holes in the cartella allow excess moisture to escape improving the visibility of nipple and also avoid a warm, wet environment which can be conducive to infection.3 We keep this dressing for 4 weeks. The senior author (AJ) innovated this technique and has used cartella-shield after nipple reconstruction for 10 years in over 350 cases satisfactorily.
References
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