The Domeless Arrow Flap: A Strategy to Enhance Realism in Reconstructed Nipples

The domeless arrow flap (DAF) introduces a simple yet effective technique for nipple reconstruction, enhancing realism by omitting the cap of the traditional arrow flap. This innovative approach allows secondary intention healing to create an irregular scar, mimicking the natural rough texture of a real nipple. Applied to 24 patients across 25 autologous breast reconstructions, the DAF achieved the best results on latissimus dorsi flaps (44% mean projection retention) and the poorest on thoracic irradiated skin (28%). Easy to perform and complication-free, the DAF is a reliable option that combines simplicity with natural aesthetics, making it a valuable addition to a surgeon's arsenal.