Modified S-Flap for Nipple Reconstruction.

Abstract

Nipple reconstruction is an important last step in the process of autologous or implant-based breast reconstruction. A multitude of techniques have been described, among others the S-flap. To prevent nipple retraction after surgery, we modified the originally described method by Cronin. By adding an S-shaped incision line, the flap can be transposed with less tension and sutured on top of the new nipple along a curved line. Furthermore, two small triangular flaps were inserted at the base for reinforcement and reduced linear contraction. Assessment was completed by measuring nipple diameter and projection with a caliper. A total of 16 patients underwent the technique, of whom 11 could be followed after 3 and 6months. Overall patient satisfaction with the aesthetic result was high, and we observed no infection or necrosis. Nipples were stable in size and shape at 6months. Although reduction of 68% in projection and 31% in diameter was observed, the nipples remained pleasantly similar to the contralateral non-operated side. The modified S-flap is a simple and reliable technique for moderate-sized nipple reconstruction. By providing more tissue at the base, size and projection remain stable and durable. Moreover, by a modified linear incision line at the base, tension and subsequent scar contraction is minimal. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .