Nipple Reconstruction Using Various Local Flaps

Ahn, Hee Chang; Choi, Eun Kyu; Hwang, Weon Jung

Abstract

The existence of numerous methods of nipple reconstruction in the literature is indicative of the difficulties encountered while duplicating a normal nipple. We have performed breast reconstruction with free TRAM flap for last 10 years, and after the breast mound reconstruction we have performed nipple reconstruction with three different methods -star flap, double opposing tab flap, and C-V flap. We compared the final outcomes of these three reconstruction methods. From March 1992 to February 2001, we experienced the 82 cases of the breast reconstruction with free TRAM and the nipples were reconstructed in 54 cases by the same surgeon. 9 cases were reconstructed with star flaps, 19 cases were reconstructed with double opposing tab flaps and 26 cases were reconstructed with C-V flaps. We compared the results of the difference of the nipple projection and the patients' satisfaction in 2 weeks and 12 months after the operation. In 12 months after the operation, the average projection of the nipple was 4.2 mm in star flap, 4.5 mm in double opposing tab flap and 6.5 mm in C-V flap. The average reduction rate of the nipple projection was 46.6%, 57.4% and 32.5% respectively in 1 year after the operation. We considered that the star flap often showed the partial necrosis on the sharp tip of the flap and the contracture of the scar tissue. We assumed that double opposing tab flap showed the good projection initially. However, as time goes, it showed a widening shape on the base of nipple and disfiguring mound of breast because of high tension in the closure. The C - V flap showed round tip and less disfiguring mound of breast because of less tension and less spreading, so it shows the least reduction rate of nipple projection. We concluded that the reconstructed nipple with C-V flap showed the least reduction of nipple projection and the most satisfactory result among these 3 methods. We recommend that the nipple should be reconstructed initially much larger than the opposite nipple considering about one-third reduction rate 1 year after the surgery.