Correction of nipple divergence in reduction mammaplasty: pillar extension flap

Lateral displacement of the nipple-areola complex becomes more obvious after reduction mammaplasty if it is not corrected. When performing mammaplasty, the Wise or vertical pattern incision lines should encompass the entire areola to prevent positioning of a pigmented area adjacent to the closure line. A high, laterally displaced areola can be repositioned using the circumvertical technique. However, in cases of breast ptosis with a laterally displaced areola, the limbs of the Wise or vertical pattern incision lines need to be modified. Transposition of the nipple-areola complex to a slightly higher location or larger area may also prevent distortion. This article describes a new modification of the vertical limbs of the Wise or vertical pattern mammaplasty that can help improve results.

This new technique was used in 16 breasts of 10 patients who underwent reduction mammaplasty. In these patients, the areola extended beyond the Wise or vertical pattern incision lines drawn on the breast. The residual areola on the lateral pillar was excised, and a matching extension was added to the medial pillar (pillar extension flap).

No cases of skin necrosis were observed. Six of the ten patients were followed up for at least 6 months, and all were satisfied with postoperative breast shape and nipple location.

The pillar extension flap is a suitable technique for correction of lateral nipple displacement during reduction mammaplasty. This procedure can be performed alone or in combination with other techniques.

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