Nipple Reconstruction with C-V Flap Using Dermofat Graft

  • SuRak EoEmail author
  • Andrew L. Da Lio


Following mastectomy, breast reconstruction is completed by creating a proper nipple-areola complex that matches to the contralateral side. The ideal method for nipple reconstruction would maintain long-term nipple projection, size, shape, texture, color, shape, and position. Although numerous techniques such as local tissue flaps, skin graft, cartilage graft, nipple-sharing techniques, and tissue-engineered structures have been evolved, a simple and reliable method that maintains nipple projection remains elusive. We have performed local C-V flaps augmented with autologous dermofat grafts harvested from excised breast tissues during breast mound revision. As a sustaining strut, dermofat graft permits greater freedom in choosing the final height of the nipple without any donor site morbidity. Use of the C-V flap augmented with a dermofat graft results in an aesthetically pleasing nipple that maintains long-term projection.


  1. 1.
    Shestak KC, Gabriel A, Landecker A, Peters S, Shestak A, Kim J. Assessment of long-term nipple projection: a comparison of three techniques. Plast Reconstr Surg. 2002;110(3):780–6.CrossRefPubMedGoogle Scholar
  2. 2.
    Farhadi J, Maksvytyte GK, Schaefer DJ, Pierer G, Scheufler O. Reconstruction of the nipple-areola complex: an update. J Plast Reconstr Aesthet Surg. 2006;59(1):40–53.CrossRefPubMedGoogle Scholar
  3. 3.
    Losken A, Mackay GJ, Bostwick J III. Nipple reconstruction using the C-V flap technique: a long-term evaluation. Plast Reconstr Surg. 2001;108(2):361–9.CrossRefPubMedGoogle Scholar
  4. 4.
    Cronin ED, Humphreys DH, Ruiz-Razura A. Nipple reconstruction: the S flap. Plast Reconstr Surg. 1988;81(5):783–7.CrossRefPubMedGoogle Scholar
  5. 5.
    Weiss J, Herman O, Rosenberg L, Shafir R. The S nipple-areola reconstruction. Plast Reconstr Surg. 1989;83(5):904–6.CrossRefPubMedGoogle Scholar
  6. 6.
    Kroll SS, Hamilton S. Nipple reconstruction with the double-opposing tab flap. Plast Reconstr Surg. 1989;84(3):520–5.CrossRefPubMedGoogle Scholar
  7. 7.
    Di Benedetto G, Sperti V, Pierangeli M, Bertani A. A simple and reliable method of nipple reconstruction using a spiral flap made of residual scar tissue. Plast Reconstr Surg. 2004;114(1):158–61.CrossRefPubMedGoogle Scholar
  8. 8.
    Cao YL, Lach E, Kim TH, Rodríguez A, Arévalo CA, Vacanti CA. Tissue-engineered nipple reconstruction. Plast Reconstr Surg. 1998;102(7):2293–8.CrossRefPubMedGoogle Scholar
  9. 9.
    Schwager RG, Smith JW, Gray GF, Goulian D Jr. Inversion of the human female nipple, with a simple method of treatment. Plast Reconstr Surg. 1974;54(5):564–9.CrossRefPubMedGoogle Scholar
  10. 10.
    Yanaga H. Nipple-areolar reconstruction with a dermal-fat flap: technical improvement from rolled auricular cartilage to artificial bone. Plast Reconstr Surg. 2003;112(7):1863–9.CrossRefPubMedGoogle Scholar
  11. 11.
    Collis N, Garrido A. Maintenance of nipple projection using auricular cartilage. Plast Reconstr Surg. 2000;105(6):2276–7.CrossRefPubMedGoogle Scholar
  12. 12.
    Rose EH. Nipple reconstruction with four-lobe composite auricular graft. Ann Plast Surg. 1985;15(1):78–81.CrossRefPubMedGoogle Scholar
  13. 13.
    Brent B, Bostwick J. Nipple-areola reconstruction with auricular tissues. Plast Reconstr Surg. 1977;60(3):353–61.PubMedGoogle Scholar
  14. 14.
    Tanabe HY, Tai Y, Kiyokawa K, Yamauchi T. Nipple-areolar reconstruction with a dermal-fat flap and rolled auricular cartilage. Plast Reconstr Surg. 1997;100(2):431–8.CrossRefPubMedGoogle Scholar
  15. 15.
    Guerra AB, Khoobehi K, Metzinger SE, Allen RJ. New technique for nipple areola reconstruction: arrow flap and rib cartilage graft for long-lasting nipple projection. Ann Plast Surg. 2003;50(1):31–7.CrossRefPubMedGoogle Scholar
  16. 16.
    Bhatty MA, Berry RB. Nipple-areolar reconstruction by tattooing and nipple sharing. Br J Plast Surg. 1997;50(5):331–4.CrossRefPubMedGoogle Scholar
  17. 17.
    Klatsky SA, Manson PN. Toe pulp free grafts in nipple reconstruction. Plast Reconstr Surg. 1981;68(2):245–8.CrossRefPubMedGoogle Scholar
  18. 18.
    Niechajev I, Sevćuk O. Long term results of fat transplantation: clinical and histologic studies. Plast Reconstr Surg. 1994;94(3):496–506.CrossRefPubMedGoogle Scholar
  19. 19.
    Sawhney CP, Banerjee TN, Chakravarti RN. Behaviour of dermal fat transplants. Br J Plast Surg. 1969;22(2):169–76.CrossRefPubMedGoogle Scholar
  20. 20.
    Bogue DP, Mungara AK, Thompson M, Cederna PS. Modified technique for nipple-areolar reconstruction: a case series. Plast Reconstr Surg. 2003;112(5):1274–8.CrossRefPubMedGoogle Scholar
  21. 21.
    Jabor MA, Shayani P, Collins DR Jr, Karas T, Cohen BE. Nipple-areola reconstruction: satisfaction and clinical determinants. Plast Reconstr Surg. 2002;110(2):457–63.CrossRefPubMedGoogle Scholar
  22. 22.
    Banducci DR, Le TK, Hughes KC. Long-term follow-up of a modified Anton-Hartrampf nipple reconstruction. Ann Plast Surg. 1999;43(5):467–9.CrossRefPubMedGoogle Scholar
  23. 23.
    Eskenazi L. A one-stage nipple reconstruction with the “modified star” flap and immediate tattoo: a review of 100 cases. Plast Reconstr Surg. 1993;92(4):671–80.CrossRefPubMedGoogle Scholar
  24. 24.
    Kroll SS, Reece GP, Miller MJ, Evans GR, Robb GL, Baldwin BJ, Wang BG, Schusterman MA. Comparison of nipple projection with the modified double-opposing tab and star flaps. Plast Reconstr Surg. 1997;99(6):1602–5.CrossRefPubMedGoogle Scholar
  25. 25.
    Hugo NE, Sultan MR, Hardy SP. Nipple-areolar reconstruction with intradermal tattoo and double-opposing pennant flaps. Ann Plast Surg. 1993;30(6):510–3.CrossRefPubMedGoogle Scholar
  26. 26.
    Wong WW, Hiersche MA, Martin MC. The angel flap for nipple reconstruction. Can J Plast Surg. 2013;21(1):e1–4.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Little JW III, Munasifi T, McCulloch DT. One-stage reconstruction of a projecting nipple: the quadrapod flap. Plast Reconstr Surg. 1983;71(1):126–33.CrossRefPubMedGoogle Scholar
  28. 28.
    Klinger F, Caviggioli F, Vinci V, Forcellini D, Maione L, Lisa A, Klinger M. Triple-V flap: nipple reconstruction using a modified C-V flap technique for long-lasting improvement of projection. Eur J Plast Surg. 2013;36(11):689–92.CrossRefGoogle Scholar
  29. 29.
    Eng JS. Bell flap nipple reconstruction-a new wrinkle. Ann Plast Surg. 1996;36(5):485–8.CrossRefPubMedGoogle Scholar
  30. 30.
    Chang WH. Nipple reconstruction with a T flap. Plast Reconstr Surg. 1984;73(1):140–3.CrossRefPubMedGoogle Scholar
  31. 31.
    Hallock GG, Altobelli JA. Cylindrical nipple reconstruction using an H flap. Ann Plast Surg. 1993;30(1):23–6.CrossRefPubMedGoogle Scholar
  32. 32.
    Cohen IK, Ward JA, Chandrasekhar B. The pinwheel flap nipple and barrier areola graft reconstruction. Plast Reconstr Surg. 1986;77(6):995–9.CrossRefPubMedGoogle Scholar
  33. 33.
    Temiz G, Yeşiloğlu N, Şirinoğlu H, Sarici M. A new modification of C-V flap technique in nipple reconstruction: rolled triangular dermal-fat flaps. Aesthet Plast Surg. 2015;39(1):173–5.CrossRefGoogle Scholar
  34. 34.
    Mukherjee RP, Gottlieb V, Hacker L. Nipple-areolar reconstruction with buried dermal hammock technique. Ann Plast Surg. 1987;19(5):421–3.CrossRefPubMedGoogle Scholar
  35. 35.
    Smith JW, Nelson R. Construction of the nipple with a mushroom-shaped pedicle. Plast Reconstr Surg. 1986;78(5):684–7.CrossRefPubMedGoogle Scholar
  36. 36.
    Vecchione TR. Reconstruction and/or salvage of nipple projection. Plast Reconstr Surg. 1986;78(5):679–83.CrossRefPubMedGoogle Scholar
  37. 37.
    Hobson MI, Williams N, Sharpe DT. The mushroom nipple-areolar reconstruction: a patient review. Ann Plast Surg. 1996;37(4):453.CrossRefPubMedGoogle Scholar
  38. 38.
    Few JW, Marcus JR, Casas LA, Aitken ME, Redding J. Long-term predictable nipple projection following reconstruction. Plast Reconstr Surg. 1999;104(5):1321–4.CrossRefPubMedGoogle Scholar
  39. 39.
    Bosch G, Ramirez M. Reconstruction of the nipple: a new technique. Plast Reconstr Surg. 1984;73(6):977–81.CrossRefPubMedGoogle Scholar
  40. 40.
    Kroll SS. Integrated breast mound reduction and nipple reconstruction with the wraparound flap. Plast Reconstr Surg. 1999;104(3):687–93.CrossRefPubMedGoogle Scholar

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© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Department of Plastic and Reconstructive SurgeryDongguk University Ilsan Hospital, Dongguk University Graduate School of MedicineGyeongGi-doSouth Korea
  2. 2.UCLA Division of Plastic and Reconstructive SurgeryLos AngelesUSA

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