Modified C-V flap for nipple reconstruction: our results in 50 patients

Various techniques have been advocated for nipple reconstruction following mastectomy, including the C-V flap. In this study, we describe a modification of the C-V flap, and present results of our first 50 patients who have had nipple reconstruction using this modified technique. Assessments were made both subjectively through a questionnaire and objectively by using a calliper to measure nipple projection. Follow up ranged from 6 to 36 months (mean 15.4 months). Three (6%) patients suffered partial flap loss which settled with conservative treatment; one patient (2%) had complete flap loss due to infection and needed repeat reconstruction. Projection of the reconstructed nipples ranged between 0.5 and 4.99 mm (mean 2.17 mm). The difference in projection between the reconstructed and contralateral normal nipples ranged between -2 and 5.2 mm (mean 1.5 mm). Mean decrease in nipple projection was 45%. Fourteen (28%) patients reported some sensory recovery of their reconstructed nipples. Using a numerical scale of one to 10 (where one indicates worst, and 10 best possible outcomes), the reconstructed nipples were rated overall as good when compared to the opposite side [mean 6.5 (1-10)]. Patient satisfaction with this technique was rated as very good [mean 7.2 (1-10)]; and similarly improvement in body image as very good [mean 7.3 (1-10)]. The modified C-V flap in nipple reconstruction is simple, reliable, and offers an easy manoeuvre to provide connective tissue support for the reconstructed nipple. Moreover it produces good projection and has a high satisfaction rate and impact on enhancing patients' perception of body image. Video clips (1-6) are included with the paper for demonstration of the modified C-V flap technique.