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

ABSTRACT

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.