C-Y Trilobed Flap for Improved Donor-Site Morbidity in Nipple-Areola Complex Reconstruction

  • Tulsi Roy
  • Daniel R. Butz
  • Zachary J. Collier
  • David H. SongEmail author


Nipple-areola complex (NAC) reconstruction is frequently the final step in postmastectomy breast reconstruction and provides patients greater satisfaction with their surgical outcomes and body image. Trilobed local flaps are reliable and technically straightforward options for NAC reconstruction given their versatility and minimal donor-site morbidity. Modifications of the technique that serve to facilitate donor-site closure and eliminate dog-ears commonly extend scar length as a result. The C-Y modification described here is a reliable and easily reproducible adaptation based on triangular closures of lateral incisions that preserves nipple projection provided by traditional trilobed flaps without increasing scar length.


  1. 1.
    Wellisch DK, Schain WS, Noone RB, Little JW III. The psychological contribution of nipple addition in breast reconstruction. Plast Reconstr Surg. 1987;80(5):699–704.CrossRefPubMedGoogle Scholar
  2. 2.
    Sisti A, Grimaldi L, Tassinari J, Cuomo R, Fortezza L, Bocchiotti MA, Roviello F, D’Aniello C, Nisi G. Nipple-areola complex reconstruction techniques: a literature review. Eur J Surg Oncol. 2016;42(4):441–65.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Eskenazi L. A one-stage nipple reconstruction with the “modified star” flap and immediate tattoo: a review of 100 cases. Plast Reconstr Surg. 1993;92:671–80.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Rubino C, Dessy LA, Posadinu A. A modified technique for nipple reconstruction: the ‘arrow flap’. Br J Plast Surg. 2003;56(3):247–51.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Spyropoulou GA, Sterne GD. Algorithm for an aesthetically pleasing nipple-areola complex with the use of the C-V flap in cases of skin-sparing mastectomy and immediate reconstruction. Aesthet Plast Surg. 2009;33(2):240–2.CrossRefGoogle Scholar
  6. 6.
    Hamori CA, LaRossa D. The top hat flap: for one stage reconstruction of a prominent nipple. Aesthet Plast Surg. 1998;22:142–4.CrossRefGoogle Scholar
  7. 7.
    Hammond DC, Khuthaila D, Kim J. The skate flap purse-string technique for nipple-areola complex reconstruction. Plast Reconstr Surg. 2007;120:399–406.CrossRefPubMedGoogle Scholar
  8. 8.
    Katerinaki E, Sircar T, Sterne GD. The C-V flap for nipple reconstruction after previous skin-sparing mastectomy and immediate breast reconstruction: refinements of donor-site closure. Aesthet Plast Surg. 2011;35(4):624–7.CrossRefGoogle Scholar
  9. 9.
    Butz DR, Kim EK, Song DH. C-Y Trilobed flap for improved nipple-areola complex reconstruction. Plast Reconstr Surg. 2015;136(2):234–7.CrossRefPubMedGoogle Scholar
  10. 10.
    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;110:780–6.CrossRefPubMedGoogle Scholar
  11. 11.
    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

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Tulsi Roy
    • 1
  • Daniel R. Butz
    • 1
  • Zachary J. Collier
    • 1
  • David H. Song
    • 2
    Email author
  1. 1.Department of Plastic SurgeryUniversity of Chicago Medical CenterChicagoUSA
  2. 2.Section of Plastic and Reconstructive Surgery, Department of SurgeryThe University of Chicago Medicine and Biological SciencesChicagoUSA

Personalised recommendations