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Improvements in nipple-areolar reconstruction have paralleled the significant developments in breast mound reconstruction that have occurred over the past decade.' l8 The importance of a quality nipple-areolar reconstruction to the overall success of total breast reconstruction has bcen emphas i~e d , '~'~.~~ and excellent summaries of nipple reconstruction have been publ i~h e d .~~ 24 Stable nipple projection has been achieved with the use of dermalfat flaps, such as the omega and skate flaps, but these methods still require the use of split-thickness skin graft^.^,^ This article is a preliminary report of a simple method of nipple reconstruction with local flaps, which does not require the use of skin grafts. The star flap technique is a logical extension of the omega and skate flaps and uses the natural scar contracture process around the base of the nipple to maintain nipple projection.The application of tattooing to nipple-areolar reconstruction has circumvented the need for skin grafting to create an areola, and the local flap techniques lend themselves to tattooing because they produce minimal scarring of the areolar dermal bed. As with other dermal-fat flap techniques for nipple reconstruction, these methods are best suited for the breast reconstructed with autologous tissue, but they may also be performed on those breasts reconstructed with expanders and implants. NIPPLE PLACEMENTNipple reco~lstruction is not performed until the breast mound is well healed, the overlying skin is supple, and the final breast shape has bcen attained, usually 6 to 8 weeks after reconstruction with autologous tissue. 1,ocation of the new nipple is determined preoperatively with the patient in the sitting or standing position. We find it is helpful to use a small round Band-Aid,

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