How Long Does the Nipple Projection Last After Reconstruction Using Purse-String Technique?

  • Yoko Katsuragi-TomiokaEmail author
  • Masahiro Nakagawa


Nipple-areola reconstruction (NAR) remains as a “finishing touch” procedure in breast reconstruction. Though it is a small surgery compared with breast reconstructions, it may affect the final expression of the whole breast. So far, numerous techniques have been reported to achieve long-lasting nipple projection. In this chapter, we will share our experience using the Hammond flap, and we will review reports discussing on the projection of the nipple after NAR.


  1. 1.
    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
  2. 2.
    Katsuragi Y, Kayano S, Koizumi T, Matsui T, Nakagawa M. How long does the nipple projection last after reconstruction using the skate flap purse-string technique? Plast Reconstr Surg. 2011;127:149e–51e.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Zhong T, Antony A, Cordeiro P. Surgical outcomes and nipple projection using the modified skate flap for nipple-areolar reconstruction in a series of 422 implant reconstructions. Ann Plast Surg. 2009;62:591–5.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Few JW, Marcus JR, Casas LA, Aitken ME, Redding J. Long-term predictable nipple projection following reconstruction. Plast Reconstr Surg. 1999;104:1321–4.CrossRefPubMedGoogle Scholar
  5. 5.
    Kroll SS, Reece GP, Miller MJ, Evans GR, Robb GL, Baldwin BJ, Schusterman MA. A comparison of nipple projection with the modified double-opposing tab and star flaps. Plast Reconstr Surg. 1997;99:1602–5.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Tanabe HY, Tai Y, Kiyokawa K, Yamauchi T. Nipple-areola reconstruction with a dermal-fat flap and rolled auricular cartilage. Plast Reconstr Surg. 1997;100:431–8.CrossRefPubMedGoogle Scholar
  7. 7.
    Mori H, Uemura N, Okazaki M. Nipple reconstruction with banked costal cartilage after vertical-type skin-sparing mastectomy and deep inferior epigastric artery perforator flap. Breast Cancer. 2012;22:95–7.CrossRefPubMedGoogle Scholar
  8. 8.
    Garramone CE, Lam B. Use of AlloDerm in primary nipple reconstruction to improve long-term nipple projection. Plast Reconstr Surg. 2007;119:1663–8.CrossRefPubMedGoogle Scholar
  9. 9.
    Winocour S, Saksena A, Oh C, Wu PS, Laungani A, Baltzer H, Saint-Cyr M. A systematic review of comparison of autologous, allogeneic, and synthetic augmentation grafts in nipple reconstruction. Plast Reconstr Surg. 2016;137:14e–23e.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    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;42:441–65.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Gilleard O, Bowles PF, Tay SKL, Jones ME. The influence of breast mound reconstruction type on nipple reconstruction projection. J Plast Reconstr Aesthet Surg. 2015;68:1310–1.CrossRefPubMedGoogle Scholar
  12. 12.
    Zenn MR, Garofalo JA. Unilateral nipple reconstruction with nipple sharing: time for a second look. Plast Reconstr Surg. 2009;123:1648–53.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Haslik W, Nedomansky J, Hacker S, Nickl S, Schroegendorfer KF. Objective and subjective evaluation of donor-site morbidity after nipple sharing for nipple areola reconstruction. J Plast Reconstr Aesthet Surg. 2015;68:168–74.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Salgarello M, Cervelli D, Barone-Adesi L. The use of a silicone nipple shield as protective device in nipple reconstruction. J Plast Reconstr Aesthet Surg. 2008;61(11):1396–8.CrossRefPubMedGoogle Scholar
  15. 15.
    Eo S, Kim SS, Da Lio AL. Nipple reconstruction with C-V flap using dermofat graft. Ann Plast Surg. 2007;58:137–40.CrossRefPubMedGoogle Scholar
  16. 16.
    Yamamoto Y, Furukawa H, Oyama A, Horiuchi K, Funayama E, Tsutsumida A, Sugihara T, Nohira K. Two innovations of the star-flap technique for nipple reconstruction. Br J Plast Surg. 2001;54:723–6.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Rosing JH, Momeni A, Kamperman K, Kahn D, Gurtner G, Lee GK. Effectiveness of the Asteame Nipple Guard™ in maintaining projection following nipple reconstruction: a prospective randomised controlled trial. J Plast Reconstr Aesthet Surg. 2009;63(10):1592–6.CrossRefPubMedGoogle Scholar
  18. 18.
    Wellisch DK, Schain WS, Noone RB, Little JW. The psychological contribution of nipple addition in breast reconstruction. Plast Reconstr Surg. 1987;80(5):699–704.CrossRefPubMedGoogle Scholar
  19. 19.
    Momoh AO, Colakoglu S, de Blacam C, Yueh JH, Lin SJ, Tobias AM, Lee BT. The impact of nipple reconstruction on patient satisfaction in breast reconstruction. Ann Plast Surg. 2012;69:389–93.CrossRefPubMedGoogle Scholar
  20. 20.
    Jabor MA, Shayani P, Collins DR Jr, Karas T, Cohen BE. Nipple-areola reconstruction: satisfaction and clinical determinants. Plast Reconstr Surg. 2002;110:1–7.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Division of Plastic and Reconstructive Surgery|Shizuoka Cancer Center HospitalShizuokaJapan

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