Nipple reconstruction with combination of modified CV flap and contralateral nipple composite graft.

BACKGROUND: Numerous nipple reconstruction methods have been proposed including the use of local flaps and composite grafts, but most methods have shown a significant loss of projection. We combined a modified CV flap with a composite graft (nipple sharing) to maximize the projection and volume of the new nipple and reduce the size of the contralateral nipple.

METHODS: In total, 30 patients underwent nipple reconstruction using a combined method between January 2013 and November 2015. This technique was selected if the diameter of the contralateral nipple was large and the thickness of the skin was less than 2 mm. After the modified CV flap was created, a composite graft from the contralateral nipple was placed between the V flaps and the C flap. The loss of projection and the ratio of the new nipple to the contralateral nipple were evaluated 12 months after surgery.

RESULTS: Nipple reconstruction was successful in all cases. The projection at 12 months after reconstruction was 68% of the initial projection, and the mean projection ratio of the new nipple to the contralateral nipple was 0.81. There was no complication in the donor nipple; in fact, the shape was improved with nipple reduction, and the scar was inconspicuous.

CONCLUSIONS: Nipple reconstruction that combines a modified CV flap and composite graft can maximize the nipple projection and provide a chance for nipple symmetry as the two components will act synergistically.