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Nipple reduction using the modified top hat flap.

Ming-Huei Cheng1, James M Smartt, Eduardo D Rodriguez

  • 1Taipei, Taiwan; and Baltimore, Md. From the Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University; Division of Plastic, Reconstructive and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine; and Johns Hopkins School of Medicine.

Plastic and Reconstructive Surgery
|November 15, 2006
PubMed
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A modified top hat flap technique effectively reduces large nipple size in Asian female patients, offering improved cosmesis and preserving sensation. This nipple reduction method is simple, reproducible, and yields natural-looking results with minimal complications.

Area of Science:

  • Plastic Surgery
  • Aesthetic Surgery
  • Microsurgery

Background:

  • Large nipples are a common ethnic characteristic among Asian females, often causing cosmetic and psychological concerns.
  • Patients seek surgical correction for disproportionately large nipples relative to areola and breast size.
  • Existing nipple reduction techniques may have limitations; a novel approach is presented.

Purpose of the Study:

  • To introduce and evaluate a new modified top hat flap technique for nipple reduction.
  • To assess the efficacy, safety, and aesthetic outcomes of this nipple reduction method.
  • To compare potential advantages over conventional nipple reduction procedures.

Main Methods:

  • The modified top hat flap technique was performed on 19 female patients (34 nipple reductions) between 2003 and 2005.

Related Experiment Videos

  • The technique involves reducing nipple diameter at the superior pole while preserving the subdermal plexus.
  • Nipple skin excision and flap elevation/trimming were performed to reduce nipple height and diameter, followed by suturing to the areola.

    • Main Results:

    • The mean nipple diameter was reduced from 16.3 mm to 7.9 mm, an average reduction of 8.4 mm.
    • Follow-up at 17.2 months showed a natural neonipple appearance with reduced projection and inconspicuous scarring.
    • No postoperative complications were observed, and nipple sensation remained unaffected (p = 0.5829).

    Conclusions:

    • The modified top hat flap technique is a simple, reproducible method for nipple reduction.
    • It effectively decreases nipple diameter and height, accommodating patient preferences.
    • Preservation of the subdermal arterial plexus and parenchymal elements ensures largely unaffected nipple sensation and circulation.