New innovations are born out of passion, vision, clinical trials, and a scrupulous process of providing patient safety. In this episode of the DiepCJourney podcast, I speak to Billy Heim, COO of BioAesthetics. He is part of a team who developed an innovation in breast reconstruction, the NAC Graft, nipple areola complex graft. Here is the summary of Episode 14: Nipple Graft, an Innovation in Breast Reconstruction, of the DiepCJourney podcast.
I am joined by Minas Chrysopoulo, MD, FACS, an internationally recognized expert in breast cancer reconstruction and shared decision making. He is president of PRMA (Plastic Reconstructive Microsurgical Associates). Dr. Chrysopoulo founded Toliman Health and is the creator of Toliman’s flagship app, Breast Advocate®, the world’s first shared decision-making app for breast cancer treatment and breast reconstruction.
Saving the Nipple/Areola in Breast Surgery
Dr. Chrysopoulo points out that a lot depends on the specific diagnosis. If there is an active breast cancer diagnosis it depends on the location of the tumor, the tumor biology, and other factors going into it from a medical standpoint. Therefore, it is important to discuss this at the time of your consult with your surgical team if you can or cannot save the nipple/areola complex at the time of mastectomy.
As Dr. C points out, there are woman who are not defined by the visual appearance of the nipple and may choose to have it removed. It is a very personal choice and one that is part of the shared decision-making conversation with your surgeon during consult for breast surgery.
If the nipple/areola complex can be saved at the time of the mastectomy, there are benefits that Dr. C points out:
- You preserve everything on the outside you can see in the mirror.
- This often gives women a sense of wholeness after breast surgery.
- Some studies have shown there is improved sensation if the nipple/areola can be saved.
Dr. C brings up a key point. Just because you save the outside nipple/areola part of the breast, it does not mean you can breast feed after mastectomy. The breast tissue is removed during mastectomy so saving the nipple/areola does not mean you can breast feed in the future. Thank you for sharing this important point, Dr. C!
When You Cannot Save the Nipple/Areola in Breast Surgery
If there are reasons you cannot save the nipple/areola in breast surgery, it can be reconstructed. PRMA performs this procedure during breast reconstruction surgery as do other leading breast reconstruction centers. There are different ways of reconstructing the nipple. Dr. C points out the upsurge in 3D-nipple tattooing is also an option for women. Meeting Billy and Nic from BioAesthetics and speaking to them about the NAC graft, Dr. C knows it holds a lot of promise. He is excited about the studies taking place we discuss in the podcast with Billy.
What is the NAC graft: Nipple Graft?
The driving force behind the NAC graft was born out of work Nicholas Pashos was doing with his Pd.D. program at Tulane University. As biomedical engineers, Nick and Billy combined their education, passion, and skills to develop this product sharing it with those who serve the breast cancer community. I want to share it with you, the patient, in this blog and podcast. You are often driving forces of change in the breast cancer community. Listen to Billy’s rendition of Nick’s “lightbulb moment” in the podcast and idea to develop the NAC graft! It is fascinating.
Think of a scaffold, a framework supporting a structure. In this case the structure is the nipple/areola. The NAC graft in simplest terms is taking a donor nipple and performing a decellularization process washing away all the cells and DNA, leaving the scaffold with the same shape and size of the donated nipple. This decellularization process is performed so there are no rejection issues for the patient receiving the NAC graft. Billy discusses the benefits, and details of the NAC in the podcast that include some of the following:
- Current and ongoing clinical trials with patients.
- Long lasting projection of the nipple.
- Pigmentation and colorization to match various skin tones.
Combined Efforts in Innovation in Breast Reconstruction
Billy discusses the ethical standards of donating the nipple areola in the podcast. The BioAesthetic team works carefully with families, donors, and Donate Life to be able to receive donated nipples for breast cancer patients. Once the clinical trials are complete then the NAC will be passed over to very experienced and highly skilled surgeons like Dr. C to use for patients who are not eligible for nipple sparing mastectomy.
Innovations in breast reconstruction take combined efforts from the product developer, surgeon, and patients. I cannot think of a better way to wrap up this summary of Episode 14: Nipple Graft, an Innovation in Breast Reconstruction than with a quote from Billy he said during the podcast.
It always takes a village, never done alone, and that’s why we’re all here, right?
Billy Heim
You can enjoy the entirety of the podcast here.