Nipple Reconstruction With Local Flaps: Star and Wrap Flaps

Abstract

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,

The angel flap for nipple reconstruction

“…A tenuous blood supply to the supporting elements of the new nipple and a lack of tissue with structural integrity incorporated in the nipple are challenging. As shown in Table 1, all local flaps rely primarily on fat as both the foundation and major structural support of the recreated nipple (1)(2)(3)(4)(5)(6)(7)11,13,(15)(16)(17)(18). These resulting nipples lack dense connective tissue that supports native nipples and can lose projection (22,23).…”

“…Paramount among these limitations is the loss of projection seen with all local flap techniques. Objective measures assessing long-term nipple projection in the literature are sparse; however, studies that have evaluated long-term follow-up cite a loss of projection of 40% or more (Table 1) (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). This problem has led many to advocate creating overprojection of the nipple to at least 150% of the contralateral side to allow for loss of projection.…”

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

“…The design of the C-V flap is similar to that of the previously described star flap. The modifications consist of a base, cap, and 2 wings [10]. Following its development in 1998, the C-V flap has become standard in numerous procedures due to its long-term satisfaction and improvements in body contour [9,11,12].…”

Reconstrução do complexo areolo-papilar: do que dispomos atualmente?

“…Este retalho descrito pela primeira vez por Anton e Hartrampf 19 em 1990. Inclui um retalho cutâneo-adiposo vertical e dois retalhos laterais de pele total orientados em ângulo de 90 graus que vão envolver o retalho central e cobrir a sua superfície subcutânea.…”