Angel Flap for Nipple Reconstruction

  • Wendy W. WongEmail author
  • Mark C. Martin


Creation of an aesthetically pleasing nipple plays a significant role in breast reconstruction as a determining factor in patient satisfaction. The goals for nipple reconstruction include minimal donor site morbidity and appropriate, long-lasting projection. The authors introduce the angel flap, which is designed to achieve nipple projection with lasting results. The lateral edges of the flap and the area surrounding the top of the nipple are de-epithelialized, and the flaps are wrapped to create a nipple mound composed primarily of dermis. Decreasing the amount of fat within core of the nipple and enhancing dermal content promote long-lasting projection. Furthermore, the incision pattern fits within a desired areolar size, preventing unnecessary superfluous extension of the incisions. This technique achieves the goals of nipple reconstruction, including adequate and long-lasting projection, without extension of the lateral limb scars.


  1. 1.
    Little JW III, Munasifi T, McCulloch DT. One-stage reconstruction of a projecting nipple: the quadrapod flap. Plast Reconstr Surg. 1983;7:126–33.CrossRefGoogle Scholar
  2. 2.
    Bosch G, Ramirez M. Reconstruction of the nipple: a new technique. Plast Reconstr Surg. 1984;73:977–81.CrossRefPubMedGoogle Scholar
  3. 3.
    Chang WH. Nipple reconstruction with a T flap. Plast Reconstr Surg. 1984;73(1):140–3.CrossRefPubMedGoogle Scholar
  4. 4.
    Hartrampf CR Jr. A dermal-fat flap for nipple reconstruction. Plast Reconstr Surg. 1984;73:982–6.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Cohen IK, Ward JA, Chandrasekhar B. The pinwheel flap nipple and barrier areola graft reconstruction. Plast Reconstr Surg. 1986;77:995–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Mukherjee RP, Gottlieb V, Hacker L. Nipple-areolar reconstruction with the buried dermal hammock technique. Ann Plast Surg. 1987;3:421–3.CrossRefGoogle Scholar
  7. 7.
    Little JW III. Nipple-areolar reconstruction. Clin Plast Surg. 1984;11:351–64.PubMedPubMedCentralGoogle Scholar
  8. 8.
    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
  9. 9.
    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;623:591–5.CrossRefGoogle Scholar
  10. 10.
    Cronin ED, Humphreys DH, Ruiz-Razura A. Nipple reconstruction: the S flap. Plast Reconstr Surg. 1988;81:783–7.CrossRefPubMedGoogle Scholar
  11. 11.
    Kroll SS, Hamilton S. Nipple reconstruction with the double opposing-tab flap. Plast Reconstr Surg. 1989;84:520–5.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    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;99:1602–5.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Anton LE, Hartrampf CR. Nipple reconstruction with local flaps: star and wrap flaps. Perspect Plast Surg. 1991;5:67–78.Google Scholar
  14. 14.
    Banducci DR, Le TK, Hughes KC. Long-term follow-up of a modified Anton-Hartrampf nipple reconstruction. Ann Plast Surg. 1999;43:467–70.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Hallock GG, Altobelli JA. Cylindrical nipple reconstruction using an H flap. Ann Plast Surg. 1993;30:23–6.CrossRefPubMedGoogle Scholar
  16. 16.
    Eng J. Bell flap nipple reconstruction—a new wrinkle. Ann Plast Surg. 1996;36:485–8.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Losken GM, Bostwick J III. Nipple reconstruction using the C-V flap technique: a long-term evaluation. Plast Reconstr Surg. 2001;108:361–9.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Rubino CLD, Posadinu A. A modified technique for nipple reconstruction: the “arrow flap”. Br J Plast Surg. 2003;56:247–51.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Eo SK, Da Lio AL. Nipple reconstruction with a C-V flap using dermofat graft. Ann Plast Surg. 2007;58:137–40.CrossRefPubMedGoogle Scholar
  20. 20.
    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;54:564–9.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Pribaz JJ, Pousti T. Correction of recurrent nipple inversion with cartilage graft. Ann Plast Surg. 1998;40:14–27.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Brent B, Bostwick J. Nipple-areolar reconstruction with auricular tissues. Plast Reconstr Surg. 1977;60:353–61.PubMedGoogle Scholar
  23. 23.
    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

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Department of Plastic SurgeryLoma Linda UniversityLoma LindaUSA
  2. 2.Gallery Plastic SurgeryMontereyUSA

Personalised recommendations