Nipple reconstruction with a modified arrow flap

Nipple reconstruction, which allows a reconstructed breast to assume a more natural look, represents the completion of the breast reconstruction journey. Several techniques have already been described in literature but unfortunately, loss of the projection of the new nipple has been a common problem for all of them. We report our experience using a personal modification of the popular arrow flap, to which we have added maneuvers to compensate for the weaknesses of the conventional procedures.

A prospective study was performed on women who required nipple reconstruction after autologous or implant-based breast reconstruction; revisions of reconstructed nipples have been also included. Patients who underwent radiotherapy after reconstruction of the breast mound were excluded from the study. The new nipples were reconstructed using our modified arrow flap. Immediate postoperative nipple projection was recorded and compared after 6 weeks and 6 months. Descriptive statistics were used to summarize the characteristics of the study patients and the results. The F-test was performed to assess the statistical significance of our findings.

Our modified arrow-flap procedure was used to reconstruct 27 nipples. The average projection reduction has been of 12.9% at 6 weeks and 19.7% at 6 months, and no statistical significance was recorded among the postoperative assessments (P=0.14). Complications have been recorded in 3 patients and consisted of 2 small wound dehiscence and 1 superficial infection.

Our modified arrow-flap method for nipple reconstruction achieves a reproducible and reliable natural look and stable projection.