Nipple Reconstruction Using a Scar-Based Modified C-V Flap

Abstract

INTRODUCTIONPatients who have lost their nipple-areolar complex (NAC) due to cancer excision surgery or trauma, or who have a congenital absence of the NAC, can experience psychological distress. Therefore, NAC reconstruction procedures have both physical and psychological impacts.Breast reconstruction is usually performed in multiple stages.Since reconstruction of the NAC finalizes breast reconstruction following mastectomy, it is important to perform this final step in a precise and delicate way with an optimal surgical technique. The 2 basic methods of NAC reconstruction are local flaps and composite grafts. The surgical techniques that have been developed for NAC reconstruction include the C-V flap, the star flap, the skate flap, the bell flap, and the arrow flap [1][2][3][4][5][6][7]. Local flaps are preferred because donor site morbidity is minimal compared to composite grafts. The C-V flap is a simple, quick, and effective method for nipple reconstruction using a local flap [8].In these surgical procedures, nipple creation and areola pigmentation are critical [9]. Successful and complete procedures for nipple reconstruction must be simple, reliable, and convenient, with good aesthetic outcomes. The scar-based modified C-V flap technique described in this study is based on the conventional C-V flap technique. The C-V flap is a simple method using a local flap, and can be performed in the outpatient department [9]. Of note, the scar-based modified C-V flap can be performed for nipple recon- Background Numerous techniques have emerged for nipple-areolar complex (NAC) over the years. Scar-based modified C-V flap technique is a new method for creating NAC, surgeons can accomplish nipple reconstruction and scar revision simultaneously. This article described the modified C-V flap technique for nipple reconstruction. This modified method is simple and reliable with good outcome. Methods To evaluate the effectiveness of our technique, we reviewed 21 patients who underwent nipple reconstruction using the scar-based modified C-V flap technique. For scar-based modified C-V flap, a C flap was designed to match the contralateral nipple in width while a V flap including scar after mastectomy was designed. The flap pedicle was centrally located. The V flap was then fixed surrounding the central part with a proper shape and volume considering the distal part of the flap that had poor vascularization. Results The average age of the 21 patients was 48.4 years. The average length of follow up was 7.4 months. Complication rate was 19.0% including projection loss in 2 cases, tip necrosis in 1 case, postoperative infection in 1 case, and wound dehiscence in 1 case. Reoperations were performed for 2 cases of projection loss, 1 case of partial flap necrosis, and 1 case of wound dehiscence. Conclusions The scar-based modified C-V flap technique is a simple and reliable method for nipple reconstruction with aesthetic outcome. Patients who have undergone this surgical technique tend to have great satisfaction with the results.