Nipple Reduction Preserving C-V Flap Tissue in Male Nipple Hypertrophy: Idea Innovation

PURPOSE: Male nipple hypertrophy is a rare condition but is a social embarrassment for individual. The currently available techniques of nipple reduction already described in the literature for female patients are discussed, but the goal of treatment is different in male patients. In male patient, the diameter as well as vertical height should be reduced simultaneously to achieve better aesthetic results. Our new technique can reduce the diameter of the hypertrophic nipple as well as the vertical height efficiently and simply. METHODS: A 19-years-old man with nipple hypertrophy on the right chest presented. The flap is designed based on the site of left nipple, symmetry, the diameter, and the projection desired. The widths of the V flaps determine projection, whereas the diameter of the C flap determines the diameter of the nipple and top of the new nipple. Unnecessary hypertrophic tissues are extirpated and the V flaps are elevated. The nipple base is reduced by purse-string suture technique. The V flaps are wrapped around, and C flap is used as a cap. RESULTS: No complication including nipple necrosis or sensory loss were found during follow-up period. The normal symmetry of the nipple contour was restored. CONCLUSION: We describe a simple technique for male nipple reduction using a C-V flap with purse-string suture. In our experience, this technique has provided good aesthetic result and patient satisfaction.

Nipple Reconstruction using the C-V Flap Technique after Breast Reconstruction with the Only Breast Expander

PURPOSE: Breast cancer is second most common cancer in women. Most of the patients with breast cancer treated with mastectomy take breast reconstruction. Nipple reconstruction is an important step in breast reconstruction. Many surgeons have investigated of nipple reconstruction using the flap technique after breast reconstruction with the autologous tissue. The objective of this study is to evaluate the results of nipple reconstruction using the C-V flap technique after breast reconstruction only with the breast expander. METHODS: From April 2006 to May 2008, the authors treated 17 patients of nipple reconstruction using C-V flap technique, who received breast reconstruction only with the breast expander. As we have predicted decrease in the size of reconstructed nipple, we designed flap a little larger than wanted nipple size. Nipple splint was applied for 4-6 months for minimizing decrease of the size of reconstructed nipple. The diameter and height of the reconstructed nipple were measured and patient's satisfaction score was assessed. RESULTS: Mean follow-up duration was 12.5 months. Among the 17 patients, the average absorption rate by height of nipple was 47.0%. Partial necrosis was noted in 1 case, and treated well with conservative management. There were no other significant complications noted. Patient's satisfactory score was assessed by the height, design and location of the nipple. The average of satisfaction score was 85%, 68%, 62% and total average was 83%. CONCLUSION: The authors experienced 17 patients of nipple reconstruction using the C-V flap technique after breast reconstruction only with the breast expander. The absorption rate of the size of the nipple, complications and patient's satisfactory score of this study were similar to those of nipple reconstruction after breast reconstruction with the autologous tissue. It is expected that nipple reconstruction after breast reconstruction only with the breast expander is safe and reliable. It is considered that a long-term study is necessary.

Nipple Reconstruction with Modified C-V Flap: C-U Flap

For ideal breast reconstruction, final nipple reconstruction with good projection, symmetrical position, shape, and texture is very important. Nowadays, C-V flap is popularly used because of its simple procedure and less donor site morbidity. But, it also has problems of maintaining good perpendicular nipple projection. Furthermore, the flap could be injured by ischemia from the overloaded tension, when it contains too much subcutaneous fat. We modified the traditional C-V flap to overcome these drawbacks and obtained satisfactory results. From April 2006 to February 2007, we applied modified C-V flap to 46 patients who underwent NAC(Nipple-Areola Complex) reconstruction for breast reconstruction. First, we modified the flap design. The tip of horizontal V-flap was changed to rectangular shape as U-flap. Secondly, we discarded the subcutaneous fat in U-flap except the base to minimize the tension after flap insetting. Thirdly, following the flap elevation, we performed donor site closure of the C-flap. Thus the donor site of U-flap could be repaired without dog ear. Finally, de-epithelization was done on the base of nipple according to the diameter of new nipple. Then a small triangular flap was made, and insetted between the junction of bilateral U-flap to minimize the contracture and inversion of new nipple. The result were followed up for an average of 8 months. There was no complication such as flap loss or infection in all 46 patients. During the follow-up periods(3-13 months), new nipple maintained symmetry and perpendicular projection to be compared with traditional C-V flap. This modification of C-U flap could overcome some drawback of traditional C-V flap and improved results were obtained.

Reconstruction of Scarred Umbilicus Using an Inverted C-V Flap: A Case Report

PURPOSE: The umbilicus is an important aesthetic component of the abdomen. Its absence is both cosmetically and psychologically distressing to the patient. Umbilical reconstruction should always be aimed at creating an umbilicus of sufficient depth and good morphology with less scarring. The C-V flap developed for nipple reconstruction was used in an inverted fashion in case of umbilical reconstruction. The aim of this article is to report our experience of scarred umbilical reconstruction using inverted C-V flap. METHODS: A 22-year-old woman presented with contracted scar tissue in the umbilical region because she had undergone surgical correction of an umbilical hernia at 5 year of age. Pedicle of the inverted C-V flap was based cephalically. For enhancing depth of the umbilicus, three anchoring sutures to linea alba were done at both lateral and caudal aspects of the umbilical tube. Primary closures were done at donor sites of the V flaps and bolster sutures were done in the caudal direction of the inverted umbilical tube. RESULTS: The patient was satisfied with the appearance of umbilicus. Major complications such as dehiscence, infection, and delayed healing did not occur. CONCLUSION: The inverted C-V flap is easy and simple technique, and it can produce a satisfactory reconstruction of umbilical structure.

Nipple Reconstruction with Dermis(Scar Tissue) Graft and C-V Flap

Nipple reconstruction is an important step in breast reconstruction after mastectomy. The authors' preferred reconstructive technique is the local C-V flap in case that a small opposite nipple is not adequate for composite graft. This flap produces an excellent reconstruction, but it is not easy to produce an adequate projection and firmness of the nipple. This article describes the technique and experience in nine patients treated over two years with dermis(scar tissue) graft for nipple reconstruction. This is the first report of application of autologous dermis(scar tissue) grafting to reconstruct a nipple primarily after breast mound reconstruction, decreasing the absorption of the reconstructed nipple and increasing the hardness. The dermis(scar tissue) is taken from scar revision and/or dog-ear correction in the second stage operation after free TRAM flap breast reconstruction. And the dermis(scar tissue) graft is inserted vertically between the local flaps and horizontally under the reconstructed nipple base. Between September 2002 and February 2005, nine patients underwent C-V flap with dermis(scar tissue) graft as a part of their nipple reconstruction. The patient's ages ranged from 28 to 55 years old (mean, 41.1 years old). The follow-up period ranged from 5 to 35 months, with an average of 14.5 months. None of the nipples showed skin flap necrosis or local infection, and uneventful wound healing. Our result showed good nipple projection with less absorption and enough firmness. Our experiences shows that dermis(scar tissue) grafts in C-V flap is a very useful method for nipple reconstruction.

Noble Tip for Reduction of V-limb of C-V Flap for Nipple Reconstruction

A nipple can be reconstructed either by nipple sharing or local flap. But donor site scar is inevitable when nipple is reconstructed with local flap method. The scar which remains inside the nipple areolar complex can be hidden by medical tattooing, but elongated scar, which cross over the areolar border leads to poor esthetic result. So as to solve this problem, we used purse string suture method. We reconstructed nipple with C-V flap for 9 patients who previously reconstructed breast with extended latissimus dorsi flap. Purse string suture with 3-0 nylon was used for donor site closure. We minimize 10.7% of the scar length with this method. Enhancement of nipple projection due to the flattening of V limb was attained in addition. We expect the reduction of V-limb of C-V flap and amount of absorption of the reconstructed nipple with purse string suture method.

Nipple Reconstruction Using Various Local Flaps

The existence of numerous methods of nipple reconstruction in the literature is indicative of the difficulties encountered while duplicating a normal nipple. We have performed breast reconstruction with free TRAM flap for last 10 years, and after the breast mound reconstruction we have performed nipple reconstruction with three different methods -star flap, double opposing tab flap, and C-V flap. We compared the final outcomes of these three reconstruction methods. From March 1992 to February 2001, we experienced the 82 cases of the breast reconstruction with free TRAM and the nipples were reconstructed in 54 cases by the same surgeon. 9 cases were reconstructed with star flaps, 19 cases were reconstructed with double opposing tab flaps and 26 cases were reconstructed with C-V flaps. We compared the results of the difference of the nipple projection and the patients' satisfaction in 2 weeks and 12 months after the operation. In 12 months after the operation, the average projection of the nipple was 4.2 mm in star flap, 4.5 mm in double opposing tab flap and 6.5 mm in C-V flap. The average reduction rate of the nipple projection was 46.6%, 57.4% and 32.5% respectively in 1 year after the operation. We considered that the star flap often showed the partial necrosis on the sharp tip of the flap and the contracture of the scar tissue. We assumed that double opposing tab flap showed the good projection initially. However, as time goes, it showed a widening shape on the base of nipple and disfiguring mound of breast because of high tension in the closure. The C - V flap showed round tip and less disfiguring mound of breast because of less tension and less spreading, so it shows the least reduction rate of nipple projection. We concluded that the reconstructed nipple with C-V flap showed the least reduction of nipple projection and the most satisfactory result among these 3 methods. We recommend that the nipple should be reconstructed initially much larger than the opposite nipple considering about one-third reduction rate 1 year after the surgery.