Creation Of The Nipple-Areolar Complex Following Breast Reconstruction
Maurice Nahabedian, MD, FACS
Director: Center for Reconstructive and Aesthetic Surgery of the Breast
Johns Hopkins Medical Institutions
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Over the years, a variety of techniques have been described to create the nipple-areolar complex following breast reconstruction. The most common methods in use today utilize the skin of the reconstructed breast in the form of local flaps. These include the Skate flap, C-V flap, and Star flap to name a few. All of these techniques are based on the principles of adjacent tissue rearrangement in order to create a 3-dimensional nipple. Other methods that are less commonly used include nipple sharing from the opposite breast and skin grafting. All of these methods can create a well-shaped nipple and all usually require a tattoo procedure to provide the color for the areola.
The technique that I use is a variation of the C-V flap that I refer to as the "elongated C-flap". My reasons for using this flap are principally related to its versatility and ease of use. The flap can be oriented in any direction or location on the breast that facilitates obtaining nipple symmetry. In addition, it can be positioned along a scar as long as it does not interfere with the blood supply to the nipple. As with all flaps, the viability and survival of the nipple depends on adequate blood supply. The blood supply for this flap is based upon the subdermal plexus of vessels from the portion of the skin that is not incised. The design of this flap and a clinical example is illustrated.