Incorporation of a Preexisting Scar in the Star-Flap Technique for Nipple Reconstruction

Abstract

This report describes the authors' currently favored method of nipple reconstruction in cases of a pre-existing scar on the breast mound that passes through the intended site of nipple reconstruction. The star flap technique incorporating a previous scar is used at least 3 months after satisfactory implant-based breast reconstruction. If the intended site of nipple reconstruction bisects through a vertical mastectomy scar, the star flap is designed as medially or laterally based with its 2 lateral limbs lying adjacent to the scar and the transverse central component incorporating the vertical scar. On the other hand, if the selected site of nipple reconstruction passes into a horizontal scar, the flap is positioned as inferiorly or superiorly based along the scar with its 2 lateral limbs adjacent to the scar and vertical central limb including the scar. Upon ensuring viability, the limbs are inset for nipple reconstruction. The flap donor wounds of the lateral limbs are closed primarily along the previous scar, and all of the scars including that of the central limb are maintained within the area of the intended areola. The procedure was used 16 times in 24 patients who have undergone bilateral implant-based breast reconstruction. All flaps were viable. One nipple reconstruction had an early complication of partial flap loss in the central flap that subsequently healed with wound care. It is possible to use a mastectomy scar in the star flap design for nipple reconstruction with no significant vascular compromise. This novel design enables positioning of the nipple in an optimal location on the breast mound in relation with the scar, use of existing scar, and inclusion of extra skin and subcutaneous tissue within the central limb. Nipple projection and volume have been satisfactory and consistently maintained.