Underwent Nipple Reconstruction Research Articles

Evaluation of the Efficacy and Safety of Pedicled Perforator Flap Technique for Salvage Nipple Reconstruction in Breast Cancer Patients: A Pilot Study.

We propose a pedicled perforator flap technique for salvage nipple reconstruction after initial nipple reconstruction fails in breast cancer patients. This is a pilot study. A total of 21 female breast cancer patients who underwent nipple reconstruction following initial nipple reconstruction fails were enrolled, and salvage nipple reconstruction based pedicled perforator flap were performed between 2016 and 2020. Operative time, perforator design, postoperative complications, follow-up duration, projection of nipple, as well as patient-reported outcomes measured by the BREAST-Q and visual analogue scale (VAS) were assessed. Sixteen patients underwent fifth lateral intercostal artery perforator reconstruction, while 5 patients underwent fifth anterior intercostal artery perforator flap reconstruction. The surgeries were successful without intraoperative complications, with a mean operative time of 67 minutes. Postoperative complications were absent. The mean follow-up duration was 18 months. The mean nipple projection was 8mm (range, 6-10mm) with a shrinkage of 20% at 6 months after surgery. The average scores for psychosocial well-being, satisfaction with breasts, and satisfaction with nipples domains of the BREAST-Q significantly increased (P < .01) at 6 months post-reconstruction. Sexual well-being subdomain showed no statistical difference (P = .9369). The VAS scores for cosmesis and patient satisfaction with surgery were 9 and 9.3, respectively. The pedicled perforator flap technique for salvage nipple reconstruction is a safe and effective approach.

Improving Long-Term Projection in Nipple Reconstruction Using a New Human-Derived Acellular Dermal Matrix

Background: Loss of projection is a very common complaint after nipple reconstruction. In this paper, we present our experience with the use of a novel human cadaver-donor-derived acellular dermal matrix, named MODA (Matrice Omologa Dermica Acellulata) from the Regional Skin Bank to improve and stabilize nipple projection after oncoplastic breast surgery. Methods: We did a retrospective analysis of patients undergoing nipple reconstruction with local flap and MODA graft after breast reconstruction between February 2019 and May 2021. The analysis was done following the Declaration of Helsinki and was approved by the ethics committee; written consent was sought from all the participants. The main evaluation criterion was nipple projection measurement, performed immediately after surgery, 6 and 12 months postoperatively. The secondary endpoints were complications and patients’ satisfaction. Results: In this study, 50 patients underwent nipple reconstruction, with 57 reconstructed nipples. All cases except six followed delayed breast reconstruction. The patients were divided into 3 groups, according to the breast reconstructive technique. There were three cases of delayed wound healing and two cases of partial necrosis, but all of the cases healed by secondary intention. Five percent of the patients (3/57 reconstructions) presented more than 60% of nipple projection loss and required another procedure. The other reconstructed nipples maintained an average of over 60% projection after 12 months. Conclusion: The described technique presents a high success rate associated with low complications. Indeed, it provides the advantages of nipple reconstruction with ADM with low costs, appears safe after radiotherapy, and has similar results when used after different reconstructive techniques.

Nipple reconstruction using modified C-V flap with purse-string sutures for maintenance of long-term nipple projection

The most common concern in nipple reconstruction is the loss of long-term nipple projection. This study aimed to demonstrate a novel method of nipple reconstruction using a modified C-V flap combined with purse-string sutures in the nipple base to maintain nipple projection. From January 2018 to July 2021, patients who underwent nipple reconstruction using the novel modified C-V flap method and conventional C-V flap were retrospectively reviewed. The ratio of projection at the 3, 6, and 12-month postoperative follow-up to the initial nipple projection was calculated and compared. A total of 116 patients were included in this study, which was comprised of 41 patients in the conventional C-V flap group (conventional) and 75 patients in the modified C-V flap with purse-string sutures group (modified). The modified group showed a significantly higher ratio of nipple projection maintenance at postoperative 3 months (79.82%, conventional; 87.25%, modified; p<0.001), 6 months (68.29%, conventional; 73.18%, modified; p<0.001), and 12 months (53.98%, conventional; 60.19%, modified; p<0.001), and a significantly lower revision rate (13/75 patients, 17.33%) than the conventional group (16/41 patients, 39.02%) (p=0.009) during a mean of 17.67-month follow-up. Nipple reconstruction using a modified C-V flap with purse-string sutures in the nipple base is a safe and effective method for the maintenance of long-term nipple projection owing to the reduction and stabilization of the nipple base.

Satisfaction with Long-Term Aesthetic and 10 Years Oncologic Outcome following Risk-Reducing Mastectomy and Implant-Based Breast Reconstruction with or without Nipple Preservation.

Simple SummaryWomen at significant increased risk of developing breast cancer may choose to undergo removal of both breasts (mastectomy) with reconstruction of the breasts using silicone implants. This study aimed to compare satisfaction, aesthetic and cancer related outcomes in women undergoing bilateral mastectomy comparing those who had the nipples removed and then a nipple reconstruction with women who had surgery with preservation of the nipples. Ninety-three women participated, sixty (64.5%) had nipple preservation and thirty-three (35.5%) nipples removed. Nipple projection was shorter in the reconstructed nipple group than the preserved nipple group. There was no significant difference in overall symmetry, satisfaction regarding nipple preservation or overall nipple satisfaction. There were no diagnoses of breast cancer in the study population who were followed up for approximately 10 years. We concluded that women who undergo nipple preserving surgery maintain long-term nipple symmetry. Nipple projection was less maintained after nipple reconstruction.Incidence of bilateral risk-reducing mastectomies (RRMs) is increasing. The aim of this study was to compare satisfaction, aesthetic and oncological outcomes in women undergoing RRM with implant-based reconstruction comparing nipple-sparing mastectomy (NSM) with skin-sparing mastectomy (SSM) (sacrificing the nipple +/− nipple reconstruction). Women who had undergone bilateral RRM between 1997 and 2016 were invited. Aesthetic outcome and nipple symmetry were evaluated using standardized anthropometric measurements. The oncological outcome was assessed at last documented follow up. Ninety-three women (186 breasts) participated, 60 (64.5%) had NSM, 33 (35.5%) SSM. Median time between surgery and participation was 98.4 months (IQR: 61.7–133.9). Of the women, 23/33 (69.7%) who had SSM underwent nipple reconstruction. Nipple projection was shorter in the reconstructed SSM group than the maintained NSM group (p < 0.001). There was no significant difference in overall symmetry (p = 0.670), satisfaction regarding nipple preservation (p = 0.257) or overall nipple satisfaction (p = 0.074). There were no diagnoses of breast cancer at a median follow up of 129 months (IQR: 65–160.6). Women who undergo nipple-sparing RRM maintain long-term nipple symmetry. Nipple projection was less maintained after nipple reconstruction. Although satisfaction with the nipples was higher in the NSM group, this did not reach statistical significance. No breast cancers developed after RRM with long-term follow up.

A Medical Tattooing Technique for Enhancing the Three-Dimensional Appearance of the Nipple-Areola Complex After Flap-Based Nipple Reconstruction.

Medical tattooing is a critical reconstructive component in the surgical process for good esthetic outcomes and improved patient satisfaction. There are many nipple reconstruction methods that use a local flap, but reduced post-operative nipple projection is a common problem. Here, we report a modified tattooing method (3D-E tattoo) that enhances the three-dimensional appearance of the nipple-areola complex (NAC), including Montgomery glands, after flap-based nipple reconstruction. The subjects were 110 consecutive patients who underwent nipple reconstruction using the C-V flap technique between April 2017 and June 2019. Of these patients, 49 received traditional medical tattooing (Group T) and 61 underwent 3D-E tattoo (Group 3D). A 10-point subjective evaluation of the 3D appearance of the reconstructed NAC was performed, and the scores were compared between the groups. The procedure time for 3D-E tattoo was about 5 minutes longer than that for traditional tattooing. The average score in Group 3D of 7.8/10 was significantly higher than that of 6.4/10 in Group T. Application of 3D techniques or "realism" in tattoo artistry has significant potential to improve the esthetic outcomes of reconstructive surgery. Adoption of simple technical skills to produce a more realistic 3D NAC permitted a symmetrical appearance to be reconstructed. 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 .

One injection for a great projection: a quick and simple procedure for nipple reconstruction.

Women attach great importance to the presence of a three-dimensional nipple upon completion of the breast reconstruction process. To meet patients’ expectations, nipple-areolar complex reconstruction should achieve symmetry in position, size, shape, texture, and color, as well as minimizing donor-site morbidity. However, it is well known that regardless of the reconstructive technique, loss of nipple projection can be reasonably expected. We developed and evaluated a quick, simple, and innovative technique using injectable Integra Flowable Wound Matrix to increase nipple projection after reconstruction. Twenty breast cancer patients who underwent nipple reconstruction resulting in unsatisfactory projection were enrolled in our retrospective study. Nipple projection was measured at the time of surgery and after 6 and 12 months. A visual analogue scale was used to assess patients’ satisfaction. Our technique yielded reliable results in terms of the long-lasting maintenance of nipple projection. This method is high-priced, but cost-effective, since one kit may suffice for three patients. Furthermore, our patients were very appreciative of this technique as a single-step, minimally invasive, painless procedure with no reported necessity of re-intervention.

De-epithelialized dermal flap for nipple reconstruction: A modified star flap.

BackgroundMultiple approaches for nipple reconstruction exist, and none is considered superior to all others. The star flap is one of the most popular methods for nipple reconstruction, but gradual height loss is a major concern. We present a new modification of the star flap that incorporates a de-epithelialized dermal flap, along with the associated surgical results.MethodsWe reviewed the medical records of patients who underwent nipple reconstruction using the modified star flap method. The design was different from the conventional star flap in that the lateral wings were changed into a trapezoidal shape and de-epithelialized dermal flaps were added. The patients were followed up at 2, 4, 6, and 12 months postoperatively, and nipple height was measured. The postoperative nipple height achieved using the modified method was compared with that obtained using the traditional method.ResultsFrom February 2013 to June 2017, 32 patients received surgery using the modified star flap, and 18 patients who underwent nipple reconstruction before 2013 comprised the conventional method group. All patients had undergone breast reconstruction with an abdominal tissue-based flap. The mean follow-up period was 14.4 months in the modified method group and 17.3 months in the conventional method group. The mean maintenance of projection at 12 months postoperatively was 56.28%±18.58% in the modified method group, and 44.23%±14.15% in the conventional method group. This difference was statistically significant (P<0.05).ConclusionsThe modified method using a de-epithelialized dermal flap provides reliable maintenance of projection in patients who have undergone abdominal tissue-based breast reconstruction.

Strattice reconstructive tissue matrix to maintain nipple projection—what do patients think?

One of the main challenges in nipple reconstruction is achieving and maintaining nipple projection. We describe a novel use of banked Strattice to provide an internal scaffold and improve long-term projection following nipple reconstruction. We assess patient and partner satisfaction with the technique compared with routine reconstruction. All patients who underwent nipple reconstruction in our unit by a single surgeon between 1/1/11 and 29/4/16 were identified retrospectively and asked to complete a satisfaction questionnaire relating specifically to their reconstruction. Those who underwent reconstruction with Strattice were compared with those that had local flaps alone. Sixty-four patients and 73 nipples were reconstructed during the study period. Eighteen nipples were reconstructed on 14 patients using Strattice. Fifty-seven patients responded to the questionnaire (90.5%). One patient developed an infection requiring removal of the banked matrix. Patients had a statistically significant increased degree of satisfaction when Strattice was used to augment their reconstruction (Mean ± SEM score 8.06 ± 0.20 versus 5.83 ± 0.16 for no Strattice; p < 0.0001). This was also the case when undressed (7.59 ± 0.15 vs 5.69 ± 0.16) but did not reach statistical significance when the patient was dressed (6.85 ± 0.19 vs 6.44 ± 0.11; p = 0.08). Patients’ partners also rated the reconstruction more highly when Strattice was used (7.71 ± 0.14 versus 6.33 ± 0.19 for no Strattice). Our study demonstrates that the use of Strattice in nipple reconstruction can lead to significantly increased rates of satisfaction among women undergoing the final stage of breast reconstruction. Level of Evidence: III Therapeutic study.

Influence of Flap Thickness on Nipple Projection After Nipple Reconstruction Using a Modified Star Flap.

In nipple reconstruction, the width, length, and thickness of modified star flaps are concerns for long-term reconstructed nipple projection. However, the flap's projection has not been analyzed, based on its thickness. The aim of the present study was to investigate how flap thickness in a modified star flap influences the resulting reconstructed nipple and achieves an appropriate flap width in design. Sixty-three patients who underwent nipple reconstruction using a modified star flap following implant-based breast reconstruction between August 2014 and July 2016 were included in this case-controlled study. The length of laterally diverging flaps was 1.5 times their width. The thickness of each flap was measured using ultrasonography, and the average thickness was defined as the flap thickness. We investigated the correlation between the resulting reconstructed nipple and flap thickness, and the difference of the change in the reconstructed nipple projection after using a thin or thick flap. The average flap thickness was 3.8 ± 1.7 (range 2.5-6.0) mm. There was a significant, linear correlation between the flap thickness and resulting reconstructed nipple projection (β = 0.853, p < 0.01). Furthermore, the difference between the thin and thick flaps in the resulting reconstructed nipple projection was significant (p < 0.01). Measuring the flap thickness preoperatively may allow surgeons to achieve an appropriate flap width; otherwise, alternative methods for higher projection might be used. 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 .

Nipple reconstruction with combination of modified C[sbnd]V flap and contralateral nipple composite graft

Numerous nipple reconstruction methods have been proposed including the use of local flaps and composite grafts, but most methods have shown a significant loss of projection. We combined a modified CV flap with a composite graft (nipple sharing) to maximize the projection and volume of the new nipple and reduce the size of the contralateral nipple. In total, 30 patients underwent nipple reconstruction using a combined method between January 2013 and November 2015. This technique was selected if the diameter of the contralateral nipple was large and the thickness of the skin was less than 2mm. After the modified CV flap was created, a composite graft from the contralateral nipple was placed between the V flaps and the C flap. The loss of projection and the ratio of the new nipple to the contralateral nipple were evaluated 12 months after surgery. Nipple reconstruction was successful in all cases. The projection at 12 months after reconstruction was 68% of the initial projection, and the mean projection ratio of the new nipple to the contralateral nipple was 0.81. There was no complication in the donor nipple; in fact, the shape was improved with nipple reduction, and the scar was inconspicuous. Nipple reconstruction that combines a modified CV flap and composite graft can maximize the nipple projection and provide a chance for nipple symmetry as the two components will act synergistically.

An Analysis of Complication Risk Factors in 641 Nipple Reconstructions

Nipple-areola reconstruction represents the completion of the breast restorative process and is associated with significant positive psychological implications. While factors such as medical comorbidities, smoking status, and radiation therapy have been shown to be associated with an increase in complications following breast reconstruction, their impact on nipple reconstruction remains largely unaddressed in the literature. An IRB-approved, retrospective review of 472 patients who underwent nipple reconstruction at Wake Forest University over a 15-year period was completed. Demographic and surgical characteristics were assessed including age, body mass index, medical comorbidities, smoking status, need for radiation, breast reconstruction type, and nipple flap used. Four hundred and seventy-two patients with 641 nipple reconstructions were included with an average follow-up of 56.5months. Radiation prior to nipple reconstruction was required in 146 breasts (22.8%). Overall, postoperative nipple projection problems occurred in 7.6% of reconstructions with a 4.1% rate of other complications, including nipple necrosis, tip loss, wound infection and wound breakdown. Implant-based reconstruction and radiation were associated with significantly more nipple projection problems (p=0.009 and 0.05, respectively). Higher rates of complications and nipple projection problems were seen with skate flap reconstruction compared to a star flap (p=0.046 and 0.001, respectively). Implant-based breast reconstruction and radiotherapy are associated with higher rates of nipple reconstruction problems. Identification of patient and surgical variables associated with increased risk of poor outcomes preoperatively could help in patient counseling and selection of the most appropriate method of breast and nipple reconstruction.

Delayed Mammoplasty with Silicone Gel Implants following DIEP Flap Breast Reconstruction.

Background:The deep inferior epigastric artery perforator (DIEP) flap is a state-of-the-art option for breast reconstruction. However, thin patients with medium- to large-size native breasts are not ideal candidates due to the limited amount of available tissue. We reviewed our experience utilizing the DIEP flap in combination with prosthetic implants.Methods:We conducted a retrospective chart review of 7 patients, totaling 11 implants, who underwent breast reconstruction with the DIEP flap and subsequent mammoplasty. All cases underwent previous mastectomies. No implant placement was offered at the time of their DIEP flap reconstruction. Immediate breast reconstruction with the DIEP flap was performed in 9 cases, whereas 2 required delayed reconstruction secondary to postmastectomy radiotherapy. No patients received postreconstruction radiotherapy. Breast asymmetry and inadequate volume were the primary indications for mammoplasty. For all cases, we used smooth, round silicone gel implants, which were placed in the subpectoral region.Results:Mean age was 43 years. One patient was actively smoking. Four patients underwent bilateral implant placement. The mean time of delay between breast reconstruction and mammoplasty was 61 weeks. Average volume of silicone implants was 229 mL. A medial pedicle vertical mastopexy was performed in 1 patient on a nonreconstructed breast to achieve symmetry. Five patients underwent nipple reconstruction. All patients underwent delayed mammoplasty without intraoperative complications and good aesthetic results.Conclusions:Delayed mammoplasty following DIEP flap breast reconstruction is a safe and feasible procedure for patients who seek an aesthetic and natural-looking breast but lack adequate abdominal tissue.

Biologic collagen cylinder with skate flap technique for nipple reconstruction.

A surgical technique using local tissue skate flaps combined with cylinders made from a naturally derived biomaterial has been used effectively for nipple reconstruction. A retrospective review of patients who underwent nipple reconstruction using this technique was performed. Comorbidities and type of breast reconstruction were collected. Outcome evaluation included complications, surgical revisions, and nipple projection. There were 115 skate flap reconstructions performed in 83 patients between July 2009 and January 2013. Patients ranged from 32 to 73 years old. Average body mass index was 28.0. The most common comorbidities were hypertension (39.8%) and smoking (16.9%). After breast reconstruction, 68.7% of the patients underwent chemotherapy and 20.5% underwent radiation. Seventy-one patients had immediate breast reconstruction with expanders and 12 had delayed reconstruction. The only reported complications were extrusions (3.5%). Six nipples (5.2%) in 5 patients required surgical revision due to loss of projection; two patients had minor loss of projection but did not require surgical revision. Nipple projection at time of surgery ranged from 6 to 7 mm and average projection at 6 months was 3–5 mm. A surgical technique for nipple reconstruction using a skate flap with a graft material is described. Complications are infrequent and short-term projection measurements are encouraging.

The Impact of Nipple Reconstruction on Patient Satisfaction in Breast Reconstruction

Nipple reconstruction is an integral part of the breast reconstruction process, as patients associate this stage with closure while providing a sense of completeness. This study evaluates the effect of nipple reconstruction on patient satisfaction with breast reconstruction. All patients at Beth Israel Deaconess Medical Center undergoing breast reconstruction between 1999 and 2006 were identified. Patient demographics and complications were collected retrospectively while aesthetic and general satisfaction was evaluated by an administered survey. Patients with nipple reconstruction at the time of survey were compared to patients without nipple reconstruction. Nine hundred two breast reconstructions were performed in 696 patients; 490 patients underwent nipple reconstruction and 206 did not. Autologous reconstruction predominated in patients with and without nipple reconstruction (61.8% and 54.8%, respectively). There were no significant differences in individual and overall total complications between groups. Patients with nipple reconstruction had significantly higher general (72.2% vs 52.8%, P<0.0001) and aesthetic (70.5% vs 46.5%, P<0.0001) satisfaction scores compared to patients without nipple reconstruction. These results were seen in unilateral and bilateral breast reconstruction. Across reconstructive techniques, patients with nipple reconstruction had higher aesthetic satisfaction. Patient satisfaction scores in all individual survey questions were statistically higher in patients with nipple reconstruction. Patients with breast reconstruction who undergo nipple reconstruction have higher general and aesthetic satisfaction compared to breast reconstruction alone. These differences were observed in both unilateral and bilateral reconstruction. Patients should be fully counseled about potential benefits nipple reconstruction can provide to all forms of breast reconstruction.

Reducing Donor Site Morbidity When Reconstructing the Nipple Using a Composite Nipple Graft

BackgroundNumerous procedures are available for nipple reconstruction without a single gold standard. This study presents a method for reducing donor-site morbidity in nipple reconstruction using a composite nipple graft after transverse rectus abdominis musculocutaneous flap breast reconstruction.MethodsThirty-five patients who underwent nipple reconstruction using a composite nipple graft technique between July of 2001 and December of 2009 were enrolled in this study. To reduce the donor site morbidity, the superior or superior-medial half dome harvesting technique was applied preserving the lateral cutaneous branch of the fourth intercostal nerves. The patients were asked to complete a previously validated survey to rate the color and projection of both nipples, along with the sensation and contractility of the donor nipple; and whether, in retrospect, they would undergo the procedure again. To compare projection, we performed a retrospective chart review of all the identifiable patients who underwent nipple reconstruction using the modified top hat flap technique by the same surgeon and during the same period.ResultsThirty-five patients were identified who underwent nipple reconstruction using a composite nipple graft. Of those, 29 patients (82.9%) responded to the survey. Overall, we received favorable responses to the donor site morbidity. Projection at postoperative 6 months and 1 year was compared with the immediate postoperative results, as well as with the results of nipples reconstructed using the modified top hat flap.ConclusionsThe technique used to harvest donor tissue is important. Preserving innervation of the nipple while harvesting can reduce donor site morbidity.

An Outcome Evaluation Following Postmastectomy Nipple Reconstruction Using the C-V Flap Technique

Nipple reconstruction often marks completion of breast reconstruction. Although it is important to overall aesthetic results, actual data on outcomes and satisfaction is limited. A retrospective review of patients who underwent nipple reconstruction using the C-V technique was performed. Patient demographics, outcomes, and patient satisfaction (1-5 scale) were assessed. There were 252 nipple reconstructions performed with an average follow-up of 38 months. Complications included: tip necrosis (3.2%), dehiscence (0.8%), and surgical revision (2%). Satisfaction scores: nipple reconstruction (3.8/5), projection (3.2/5), symmetry (4.2/5), and tattooing (3.2/5). Tissue expander reconstructions had the lowest satisfaction in all categories except breast sensation. Latissimus dorsi reconstruction had the highest satisfaction, however, they also had the highest complication rate. The most common complaint was lack of projection (38%). The C-V technique is a safe and effective procedure; patients are satisfied and would undergo the procedure again. Autologous tissue reconstructions had worse sensation, however, patient satisfaction was higher. Although patients are generally satisfied, room for improvement exists.

A modified technique for nipple reconstruction: the ‘arrow flap’

It is well known that nipples reconstructed using local tissue flaps slowly flatten. Furthermore, patients with implant reconstruction show the highest amount of nipple projection loss.This article describes some modifications to the technique proposed by Thomas et al in order to maintain flap projection.We undertook a prospective study to evaluate the effectiveness of our technique, named ‘arrow flap’. We compared a series of patients with unilateral breast reconstruction (16 implants, 16 TRAM flaps) who underwent nipple reconstruction using either the ‘modified star flap’ or the ‘arrow flap’. The statistical significance of the results was determined by Student's t test.The arrow flap proved to have a higher residual projection and these results were statistically significant. Furthermore, it has been equally useful on implant and autologous reconstructions. This technique is easy to learn and to perform. The procedure is reliable and patient satisfaction and compliance are very good.

Nipple Reconstruction Using the C-V Flap Technique: A Long-Term Evaluation

Numerous procedures are available for nipple reconstruction with no true universal favorite. This study presents long-term follow-up data for nipple reconstruction using the C-V flap technique. Patients were identified by searching the Breast Reconstruction Database, and they were asked to return for a follow-up visit. All those who underwent nipple reconstruction using the C-V flap technique between January of 1992 and December of 1996 were reviewed in an attempt to conduct a long-term follow-up evaluation. The response was poor, and 11 patients participated in the study and returned for follow-up. They all completed a questionnaire, which focused on patient satisfaction using a visual analogue scale. Nipple measurements were taken with a caliper and compared with the opposite breast for symmetry. Fourteen nipple reconstructions were evaluated in 11 patients with an average follow-up of 5.3 years. All patients had undergone transverse rectus abdominis musculocutaneous (TRAM) flap reconstructions. Patient satisfaction was 42 percent with nipple projection, 62 percent with pigmentation, and 26 percent with sensation. Overall patient satisfaction with the procedure was 81 percent. Average nipple projection of the reconstructed nipple was 3.77 mm and was not statistically different when compared with the opposite nipple. Long-term subjective evaluation of the C-V flap technique does report a loss in nipple projection; however, overall patient satisfaction at 5.3 years is good, as is the ability to restore symmetry with the opposite breast.